Helicobacter pylori infection in patients with selective immunoglobulin a deficiency

Abstract

SummarySelective immunoglobulin A (IgA) deficiency (IgAD) is the most common primary immunodeficiency in the western world. The aim of the study was to investigate the prevalence and clinical characteristics of Helicobacter pylori-infected dyspeptic patients with IgAD. Case samples were drawn from all subjects ! 12 years of age (n 5 104729) who had undergone serum total IgA measurements during 2004-14 for any reason at Leumit Healthcare Services (Israel) and had serum total IgA < 0Á07 g/l. The control group was comprised of a random sample of remaining patients with a case-control ratio of 10 controls for each case. The dyspeptic diseases were identified and retrieved from Leumit Health Care Services electronic database using specific ICD-9-CM diagnostic codes. The case group included 347 subjects and the control group 3470 subjects. There were no significant differences in the prevalence of patients with dyspepsia [84 (24Á2%) versus 821 (23Á6%) for cases and controls, respectively]. Additionally, there was no difference in a proportion of dyspeptic H. pylori-positive subjects [59 (17Á1%) versus 524 (15Á1%)] between the case and control groups. Only 59 (17%) among the 347 IgAD patients underwent gastroscopy. A significantly larger proportion of case subjects experienced several forms of gastritis [13 (61Á9%) versus 38 (21Á6%), P < 0Á001), duodenal ulcers [seven (33Á3%) versus 19 (10Á8%); P 5 0Á01] and nodular lymphoid hyperplasia (NLH) [two (9Á5%) versus none; P 5 0Á011]. IgAD is not associated with increased prevalence of H. pylori-associated dyspepsia; nevertheless, H. pylori-infected dyspeptic IgAD subjects experience more EGD-proved gastritis, duodenal ulcers and NLH.

The Epidemiology and Clinical Manifestations of Autoimmunity in Selective IgA Deficiency

“…[22] SIgAD does not appear to be associated with H. pylori associated dyspepsia, but among patients with symptomatic H. pylori dyspepsia, those with SIgAD have a significantly higher incidence of gastritis, duodenal ulcers, and nodular lymphoid hyperplasia. [33] Nodular lymphoid hyperplasia (NLH) has been noted in individuals with SIgAD, but it is difficult to determine whether this is a true association because NLH is asymptomatic in most cases, and therefore may go undiagnosed in the absence of other GI pathology. It is also known to be associated with Giardia lamblia infection and celiac disease, two conditions that are more common among individuals with SIgAD, further clouding the picture.…”

Update on Infections in Primary Antibody Deficiencies

“…In patients older than 12 years, one study reported that, although the prevalence of H. pylori -associated dyspepsia was not higher in SIAD, those patients who had H. pylori infection experienced more esophagogastroduodenoscopy (EGD)-proven gastritis, duodenal ulcers, and nodular lymphoid hyperplasia ( 132 ). Other studies showed that H. pylori infection was one of the most common gastrointestinal infections in children (< 17 years) with SIAD ( 133 , 134 ).…”

Inborn Errors of Immunity and Cancer

“…The types of malignancies reported in patients with selective IgA deficiency are similar to those reported for CVID, especially lymphoid and gastric malignancies [ 75 ]. The increased prevalence of gastric cancer in patients with selective IgA deficiency could result from a diminished defence against H. pylori in the gastric mucosa, highlighting the immunoprotective role of IgA against this type of malignancy [ 76 , 77 ]. In a case report, a patient with selective IgA deficiency was described with γ/δ-type abdominal T cell NHL [ 78 ].…”