Influence of serum vitamin D level on Helicobacter pylori eradication: A multi‐center, observational, prospective and cohort study

Abstract

Objectives This study was designed to test whether serum vitamin D levels affected Helicobacter pylori (H. pylori) infection and eradication rates. Methods A multicenter observational prospective cohort study was conducted. A total of 496 H. pylori− positive (H. pylori+) and 257 H. pylori‐negative (H. pylori−) patients were enrolled from four hospitals in China. Baseline serum vitamin D levels were measured and a 13C‐urea breath test (UBT) was performed for all the participants. The H. pylori+ patients were divided into two subgroups based on their serum vitamin D levels (<10 or ≥10 ng/mL). A second 13C‐UBT was performed between 4 and 8 weeks after 14‐day bismuth‐containing quadruple eradication therapies. Factors potentially affecting H. pylori eradication were determined using a questionnaire survey. Results Serum vitamin D levels were significantly lower in the H. pylori+ group than in the H. pylori− group ([17.0 ± 6.9] ng/mL vs [19.2 ± 8.0] ng/mL, P = 0.000). H. pylori eradication rate significantly differed between patients with serum vitamin D levels of <10 ng/mL and ≥10 ng/mL (71.7% vs 87.3%, P = 0.005). A multivariate analysis showed that having serum vitamin D level ≥10 ng/mL was an independent risk factor for a successful H. pylori eradication (odds ratio 0.381, 95% confidence interval 0.183‐0.791, P = 0.010). Conclusions Serum vitamin D level may affect H. pylori infection and its eradication. Randomized controlled trials are needed to find out whether vitamin D supplements may increase the H. pylori eradication rate.

Effect of vitamin D on Helicobacter pylori infection and eradication: A meta‐analysis

“…Our search identified 182 related references, of which 10 papers met our inclusion criteria . The flowchart describing the process of study selection is shown in Figure .…”

A Review of the Potential Benefits of Increasing Vitamin D Status in Mongolian Adults through Food Fortification and Vitamin D Supplementation

“…A further review in 2017 reported accumulating evidence from gastric cancer cells, animal models, and clinical trials to suggest that vitamin D deficiency may increase the risk and mortality of gastric cancer, implying that vitamin D supplementation might be a safe and economical way to reduce gastric cancer risks both prospectively and during treatment [73]. Supporting evidence that vitamin D has the potential to reduce the risk of gastric cancer is provided by studies reporting that vitamin D repletion can eradicate Helicobacter pylori infection, itself an important risk factor for gastric cancer [74,75].…”

“…Pregnant women in Mongolia were found to have preeclampsia rates of about 4% (4.4% in Ulaanbaatar and 3.5% in rural regions) [101]—an important risk factor for preterm birth and low birth weight [102]. A meta-analysis involving 21 studies reported that low vs. high maternal 25(OH)D concentration was associated with an OR of 1.62 (95% CI, 1.36 to 1.94) for preeclampsia [75], the OR for the Asian sub-population being 2.07 (95% CI, 1.51 to 2.85). In addition, serum 25(OH)D concentrations in the second and third trimesters of pregnancy were more important risk predictors for preeclampsia than those in the first trimester (OR for second/third trimester = 1.93 [95% CI, 1.43 to 2.60]).…”

Authors’ reply

“…Moreover, a recent randomized study showed that susceptibility-guided therapy in a high-resistance area was equally effective as a local empirical regimen [3], while another randomized study failed to reveal superiority of genotypic resistance-guided therapy over a properly designed empirical treatment for eradication of refractory H. pylori infection [4]. For these reasons, the Greek consensus has stated (Statement 26) that culture and antimicrobial susceptibility testing is not recommended before first-line therapy, and that susceptibility-guided therapy should be provided as a rescue treatment, especially after second-line treatment has failed.On the other hand, the effect of vitamin D (vitD) on H. pylori infection and eradication rates has been widely investigated recently [5]. VitD, apart from its well-known role in calcium and phosphorus metabolism, has been proven to be potent immune modulator of the adaptive immune system, stimulating the innate immune response upon infection [6].…”

“…On the other hand, the effect of vitamin D (vitD) on H. pylori infection and eradication rates has been widely investigated recently [5]. VitD, apart from its well-known role in calcium and phosphorus metabolism, has been proven to be potent immune modulator of the adaptive immune system, stimulating the innate immune response upon infection [6].…”