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Background: Proton Pump Inhibitors (PPIs) are commonly taken and many times overused when gastroesophageal reflux disease or peptic ulcer disease due to Helicobacter Pylori (H pylori) is suspected. Many times these medications are prescribed before these diagnoses are properly made according to current guidelines. Several studies suggest that, due to PPI therapy, H. pylori can migrate from the antrum to the corpus of the stomach. Because of the overuse of PPIs, its risk of adverse events and the suspicion of H. Pylori migration, more studies are needed to determine its appropriate use.

Objective: To determine whether or not pre-existing H. Pylori colonies will migrate in the stomach when a patient is taking PPI therapy.

Methods: We analyzed the presence of H pylori in both the antrum and the body of the stomach, determined by biopsies taken during esophagastroduodenoscopy (EGD) in patients who took proton pump inhibitors during an 8 week course. The goals were: H. Pylori seen versus H. Pylori not seen in patients taking proton pump inhibitors as well as those not taking proton pump inhibitors and what was the change in density of colony at the biopsy site. We included the subjects who had biopsies done from both the body and antrum; if they had only biopsied in either the antrum or the corpus, they were excluded. All EGDs were performed by licensed Gastroenterologist attending physicians at Gastrodiagnostics Surgery Center, which is located in West Paterson, New Jersey, U.S.A. All pathology slides were viewed and interpreted by licensed Pathologists at the same site.

Results: A total of 550 subjects had an EGD for gastrointestinal related symptoms, including gastroesophageal reflux disease, epigastric pain and dyspepsia during the years of 2009 and 2010, each patient was followed over a two month period. We included 99 patients in our analysis who were found to have the presence of H. Pylori in the biopsy specimens taken from either the corpus or the antrum of the stomach. Out of these 81 (81%) subjects found to have H. pylori in the biopsy specimens collected from the antrum as well as corpus. The other 18 subjects (18%) were found to have H. pylori in the biopsy specimens collected from only the corpus. Out of these 18 subjects, 14 (14 %) used proton pump inhibitors for more than 2 weeks prior to EGD, while 4 subjects did not. Only 2 (2%) subjects were found to have H. pylori in the biopsy specimens collected from only the antrum. The results suggest that PPIs may alter the size of colonies in the primary location of the colony of H. pylori, but may allow for movement of the colonies to other regions of the stomach, such as the corpus.

Conclusions: Proton pump inhibitors (PPIs) may cause migration of H. pylori colonies from the antrum to the corpus of the stomach, as well as diminish the density of H. pylori colonies in the antrum. Hence, in order to diagnose H. pylori in patients that are using PPIs, we recommend the biopsies to be performed in both the antrum and the corpus of the stomach.