High Gastrin Levels Caused by Several Factors

Doctor holding endoscope before gastroscopy.
Elevated gastrin levels can be a sign of hypergastrinemia or gastrinoma. However, other factors may be the cause. Investigators sought to better understand the difference.

Individuals on proton pump inhibitors (PPI), those with active H. pylori infection, and those with gastric preneoplasia demonstrated significantly elevated fasting serum gastrin concentrations, according to a study published in Frontiers in Endocrinology.

Investigators studied 982 people from the Gastroenterology Unit of Royal Liverpool University Hospital for an elective outpatient upper gastrointestinal endoscopy between May 2008 and July 2011. Prior to the procedure, participants fasted for at least 12 hours and had blood drawn to assess fasting serum gastrin concentration and H. pylori serology. Biopsy samples were sent to laboratories to perform histological analysis of macroscopic abnormalities from the gastric antrum and corpus.

Enrollees were divided into four primary groups. One group was deemed ‘normal’ (those with no or minor gastric abnormalities and no PPI use within 2 weeks, n=233) and a second group were regular PPI users (n=301) who were divided into standard (n=244), high (n=39), and low dose (n=18) PPI use. A third group had an active H. pylori infection (n=164) and divided into those taking PPIs within the last 2 weeks (n=56) and those who did not (n=108). The fourth group were people with gastric preneoplasia (n=284) who were divided into those who had gastric preneoplasia in the antrum only (n=161) or gastric preneoplasia in the corpus, potentially in addition to the antrum (n=123).

The median fasting gastrin concentration in the normal group was 20 pM; the PPI user group was 46 pM (P <.0001); the active H. pylori infection group was 27 pM (P <.0001); and the gastric preneoplastic group was 48 pM (P <.0001) for the corpus and 25 pM (P <.01) for the antrum. Enrollees with PPI use and active H. pylori infection had a fasting serum gastrin concentration level of 50 pM. People with PPI use and either gastric antral or corpus preneoplasia had fasting serum gastrin concentration levels of 53 pM and 90 pM, respectively.

Investigators noted several limitations of the study, including its single-center design and the two-week cutoff to define PPI use, which may not have accounted for prolonged effects of PPI use on serum gastrin concentrations.

“Our results demonstrate that although H.pylori infection, gastric preneoplasia, and PPI use can all cause elevations of fasting serum gastrin concentrations, the extent of this increase is not predictable, and many patients who have risk factors still demonstrate normal fasting serum concentrations of this hormone.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Veysey-Smith R, Moore AR, Murugesan SV, et al. Effects of proton pump inhibitor therapy, H. pylori infection and gastric preneoplastic pathology on fasting serum gastrin concentrations. Front Endocrinol (Lausanne). 2021;12:741887. doi:10.3389/fendo.2021.741887