Active Helicobacter pylori Infection is Independently Associated with Nonalcoholic Steatohepatitis in Morbidly Obese Patients

Abstract

Nonalcoholic fatty liver disease (NAFLD) emerges as an important global burden and Helicobacter pylori infection (Hp-I) has been suggested as a risk factor of NAFLD, although controversy exists. This retrospective study aimed to investigate a potential impact of active Hp-I on NAFLD severity in morbidly obese patients, subjected to bariatric surgery and gastric biopsy for documentation of Hp-I. Of 64 eligible participants, 15 (23.4%) were diagnosed with active Hp-I, showing higher rates of nonalcoholic steatohepatitis (NASH) than those without Hp-I (86.7% vs. 26.5%, respectively; p < 0.001). Concerning histological lesions, steatosis grade (p = 0.027), ballooning (p < 0.001), lobular inflammation (p = 0.003), and fibrosis stage (p < 0.001) were also more severe in Hp-I positive patients. Likewise, liver function tests, insulin resistance, dyslipidemia, and arterial hypertension were significantly higher in Hp-I positive patients. Hp-I was independently positively associated with NASH (beta = 3.27; p = 0.002), severe NASH (beta = 2.37; p = 0.018), and the presence of fibrosis (beta = 3.86; p = 0.001) in a binary regression model, after adjustment for potential confounders. In conclusion, active Hp-Ι was independently associated with NASH and fibrosis, findings offering potential clinical implication.

Impact of Helicobacter pylori‐linked metabolic syndrome on non‐alcoholic fatty liver disease and its connected atrial fibrillation risk

“…infection plays a role on the pathophysiology of NAFLD and AF. 2 We thank their interest in our study. Helicobacter pylori infection has been considered as a chronic inflammation status, and may play a role on the development of cardiovascular disease, 3 although the causality is still with controversies.…”

The role of the gut microbiome and exercise in non-alcoholic fatty liver disease

“…Recently, H. pylori has also been independently associated with advanced stages of NASH. 38 Some suggested mechanisms are that it may inhibit the release of leptin from white adipose tissue, promote liver stearoyl-CoA desaturase-1 (SCD1) and increase hepatic fatty deposition. The effect of H. pylori on NAFLD could also be driven by the effects this bacterium has on gut dysbiosis, endotoxemia and dyslipidemia.…”

Reconsidering the “protective” hypothesis of Helicobacter pylori infection in eosinophilic esophagitis

“…124 The gastric mucosa of H. pylori-infected patients (affected by moderate and severe gastritis) is also infiltrated by basophils, and H. pylori-derived peptide (H. pylori (2-20)) appears to be a potent basophil chemoattractant. 111 The potential role of H. pylori (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) basophil chemoattractant, however, in the pathogenesis of EoE remains to be elucidated.…”

“…132 In this regard, H. pylori-related apolipoprotein E (ApoE)-4 polymorphism, the most common known genetic risk factor for AD onset, could be connected with dysphagic symptoms in such elderly patients; an association between H. pylori infection and ApoE4 polymorphism contributes to the pathogenesis of AD and, possibly, of glaucoma. 133 (2) MAFLD (where the evidence of H. pylori infection as the contributor accumulates 5,[17][18][19][20][21][22] and EoE seem to be the common topic in pediatric gastroenterology. 134 Lastly, the genetic factors are linked with EoE.…”

“…Clearly confirmed such manifestations include iron deficiency anemia, idiopathic thrombocytopenic purpura, vitamin B 12 deficiency, and to a lesser extent, dermatological manifestations. 16 Additionally, such disorders include metabolic syndrome-related nonalcoholic fatty liver disease, 5,[17][18][19][20][21][22] currently renamed MAFLD (metabolic (dysfunction)-associated fatty liver disease), 23 and neurodegenerative diseases; 16,[24][25][26] H. pylori infection has been linked with mild cognitive impairment, Alzheimer's disease (AD), multiple sclerosis, and primary doi: 10.1111/nyas.14449 open-angle glaucoma (defined as "ocular AD"), at least in certain ethnic subpopulations. [27][28][29][30] In summary, despite some controversy, an emerging number of publications supports the pleiotropic and beyond the stomach/GIT pathogenicity of H. pylori.…”