Low prevalence of H. pylori infection in patients with gastroparesis

Background: The histopathology of the gastric mucosa in patients with gastroparesis, a condition characterized by gastric retention without obstruction, has not been described. Aim: To test the hypothesis that reactive gastropathy is more common in patients with gastroparesis than in subjects with normal gastric motility. Methods: We compared the prevalence of reactive gastropathy, Helicobacter pylori infection, chronic gastritis, and intestinal metaplasia in patients with and without a clinical diagnosis of gastroparesis extracted from a national database of subjects with gastric biopsies (1/2008-6/2012). Results: There were 3040 patients with gastroparesis (median age 58 years, 67.3% women) and 575,895 controls (median age 57 years, 62.0% women) with no evidence of gastroparesis. Reactive gastropathy was marginally more prevalent in patients with gastroparesis (18.9%) than in controls (17.0%). In contrast, H. pylori gastritis was present in 10.8% of controls, but only in 5.9% patients with gastroparesis (OR 0.52; 95% CI 0.45-0.61). Intestinal metaplasia was also less common in patients with gastroparesis (2.8% versus 3.9%; OR 0.82; 95% CI 0.58-0.89). Conclusions: The low prevalence of H. pylori infection in gastroparesis could be explained by higher rates of previous eradication, conditions unfavourable to the survival of H. pylori, or a protective effect of mucosal inflammation against the development of motility disorders.