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Physiology · Gastrointestinal physiology: Helicobacter pylori and gastrin
Sample itemA 40-year-old man with duodenal ulcer has antral-predominant Helicobacter pylori infection, a raised fasting gastrin and high acid output. A secretin stimulation test does not raise gastrin. What is the mechanism of the hypergastrinaemia?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Antral inflammation reduces somatostatin from D cells, removing inhibition of gastrin release
Antral infection lowers D-cell somatostatin and raises antral pH through ammonia production, both of which release G cells from inhibition. Gastrin and acid output rise, favouring duodenal ulcer. In a gastrinoma secretin paradoxically raises gastrin; here it does not.
Option by option
A. Antral inflammation reduces somatostatin from D cells, removing inhibition of gastrin release (correct)
Correct. Reduced somatostatin disinhibits gastrin release.
B. Increased secretin release from duodenal S cells
Secretin inhibits gastrin release in normal subjects.
C. Destruction of parietal cells causing achlorhydria
Achlorhydria raises gastrin but would lower acid output, which is not seen here.
D. Autonomous gastrin secretion by a pancreatic tumour
A gastrinoma would show a gastrin rise after secretin.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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