Reuben Veysey-Smith

Medical Student Prize

“Investigating the Relative Impacts of Proton Pump Inhibitor (PPI) Therapy, H.pylori-induced Gastritis and Gastric Mucosal Atrophy on Fasting Serum Gastrin Concentrations.”

Hypergastrinemia is a common scenario encountered in modern clinical practice, with multiple potential implications. Patients with an underlying malignant cause such as Zollinger Ellison Syndrome (ZES) may have a markedly raised fasting gastrin concentration. However, there is considerable overlap between that of ZES and common clinical factors such as atrophy, PPIs and H. pylori infection and this overlap can result in patients undergoing unnecessary tests to determine whether an abnormal result is instead a ‘false positive’. Some of these additional tests can be unpleasant and/or expensive such as endoscopies and CT/MRI scans.

This project aims to define what a standard fasting gastrin concentration may be in these groups compared to normal. By understanding the degree to which these common clinical factors affect gastrin concentration, it may be possible to attribute a raised gastrin concentration to a benign cause instead of unnecessarily investigating patients for a malignancy.

The team recruited a cohort of patients who had previously undergone endoscopy for GI conditions. Gastrin levels from blood samples were compared in 233 normal patients, alongside 301 patients receiving PPIs, 164 patients with H. pylori infection status and 284 patients with atrophic gastritis. All the investigated groups analysed had a significantly higher fasting median gastrin concentration when compared to the ‘normal’ control group. However, between these groups, results varied across several factors including use of PPIs.

The results of this study will hopefully be able to guide clinicians in the future when investigating a patient with hypergastrinemia. In addition, concerns have been raised over recent years that a small proportion of patients who take PPIs for long periods of time may have an increased risk of developing stomach or oesophageal cancer as a result of having hypergastrinaemia.

“Our results may in time contribute to being able to work out an individual’s risk and therefore assist with safer long term prescribing of this type of medication. I hope this work and any work I complete in future will aid clinicians, including myself, to give the best care possible to patients.”

Why did you choose this project?

“Throughout my medical training, I have always had a passion for research. In addition, I have a strong interest in gastroenterology and currently I am considering pursuing a career in this speciality. I also have a particular interest in cancer development. Therefore, this research project, with its primary aim of investigating whether certain common clinical conditions may increase a person’s risk of developing gastric cancer, whilst doing an MRes, gave me the chance to further all these interests and to produce my own novel findings.”