Overall, acute gastric inflammation (early-stage gastritis) may lead to increased total globulin due to increased immunoglobulins & inflammation. However, chronic inflammation and compromised protein digestion from a long-standing hypochlorhydria may lead to protein insufficiency and decreased total globulin
Globulins are non-albumin proteins that represent approximately 40% of total circulating protein under normal conditions, and albumin represents the remaining 60%. In general, these proteins bind and transport compounds such as hemoglobin, thyroid hormone, sex hormones, cortisol, iron, and lipids (as lipoproteins), or they function as immunoglobulins (antibodies) (Gropper 2021, Pagana 2019).
Increasing globulin creates an increased “gamma gap” (total protein minus albumin = total globulins) that can be considered a marker of inflammation or infection (Juraschek 2015). An increasing total globulin level is associated with all-cause mortality at a level of 2.9 g/dL or above (Yang 2018). As globulin levels increase, the albumin to globulin ratio (A/G ratio) will decrease which can be seen with inflammation, multiple myeloma and other malignancies, and autoimmune disorders (Mastenbjork 2020).
Assessing globulin levels in relation to gastrointestinal function requires information about the client’s nutritional status, liver function, and immune function/activation.
For example, chronic insufficient intake of protein (malnutrition) or insufficient protein digestion(e.g., due to hypochlorhydria) can decrease globulin levels and may be associated with mild to moderate inflammation. However, if inflammation is severe or infection is present, an increase in total globulin level will reflect the increase in inflammatory immunoglobulins.
Other parameters that must be considered when assessing total globulin levels include immune activation or insufficiency (reflected by immunoglobulin levels) and liver function (most non-antibody globulins are produced in the liver).
References
Gropper, Sareen S.; Smith, Jack L.; Carr, Timothy P. Advanced Nutrition and Human Metabolism. 8th edition. Wadsworth Publishing Co Inc. 2021.
Juraschek, Stephen P et al. “The Gamma Gap and All-Cause Mortality.” PloS one vol. 10,12 e0143494. 2 Dec. 2015, doi:10.1371/journal.pone.0143494
Mastenbjork, M., and S. Meloni. Lab Values: Everything You Need to Know about Laboratory Medicine and Its Importance in the Diagnosis of Diseases. Medical Creations, 2020.
Pagana, Kathleen Deska; Pagana, Timothy J.; Pagana, Theresa N. Mosby's Diagnostic and Laboratory Test Reference. Elsevier Health Sciences. 2019.
Yang, Ming et al. “The gamma gap predicts 4-year all-cause mortality among nonagenarians and centenarians.” Scientific reports vol. 8,1 1046. 18 Jan. 2018, doi:10.1038/s41598-018-19534-4