Low prevalence of Helicobacteraceae in gall-stone disease and gall-bladder carcinoma in the German population

Abstract

Colonisation of the hepatobiliary system with bile-resistant Helicobacter spp. has been proposed as a novel risk-factor in the pathogenesis of gall-bladder carcinoma (GBC). There are reports that biliary Helicobacter colonisation is frequent in countries with a high incidence of gall-bladder carcinoma. However, the prevalence of Helicobacteraceae in the gall-bladders of patients with GBC in Germany, a region with a low incidence of GBC, is unknown. Therefore, gall-bladder tissue from 99 patients who had undergone cholecystectomy was tested, including 57 cases of gall-stone disease (GSD), 20 cases of GBC, and 22 control patients. The presence of Helicobacter spp. was investigated by culture, immunohistochemistry and a group-specific PCR targeting the 16S rRNA gene of all currently known Helicobacteraceae. Of the 99 cases investigated, only one patient with GSD was PCR-positive for Helicobacteraceae. For this individual, sequence analysis of the 16S rRNA gene showed that it had homology closest to the 16S rRNA sequence of Helicobacter ganmani. Helicobacteraceae were not detected by culture or immunohistochemistry. The low prevalence of Helicobacteraceae in the gall-bladders investigated suggests that Helicobacteraceae do not play a predominant role in the pathogenesis of GSD and GBC in the German population. The low prevalence could be a possible explanation for a relatively low incidence of GBC in the German population, despite the fact that GSD, the major risk-factor for GBC, is highly prevalent.

Enterohepatic Helicobacter other than Helicobacter pylori

“…Its survival in such an inhospitable environment as the bile could be favored by the peptidase enzymes that these germs have (25). The role that these bacteria could play in the lithogenesis has been investigated in different projects, in which the presence of H. bilis (47,48), H. pullorum (49) H. hepaticus (48,50) and H. ganmani (51) has been studied with different techniques (PCR, serology and culture, among others) and in different samples (blood, bile, gallbladder) in patients with cholelithiasis and in control subjects. The results, although very heterogeneous, show greater prevalence of lithiasis in EHH infected patients in every case.…”

“…In this regards, several studies have been made in an attempt to know the role of EHH in acute and chronic cholecystitis (15,51,(53)(54)(55)(56). The results obtained are very heterogeneous, with a prevalence of EHH in cholecystectomy specimens by these conditions of 39 % in Chile (15), while in Germany it is 2 % (51).…”

“…In this way, already previously-mentioned studies (47,48,51,53,54) and others (57)(58)(59)(60) evaluated the presence of Helicobacter DNA by PCR in cholecystectomy samples. The results, as in the previous point, were very diverse so that it is not possible to draw definitive conclusions.…”

Prevalence of Helicobacter spp in chronic cholecystitis and correlation with changes on the histological pattern of the gallbladder

“…The prevalence of infection in the digestive tract by Helicobacter spp varies in the population studied, suggesting epidemiological differences in the distribution of the bacillus in various countries [6][7][8] . The true prevalence and relationship of different species of helicobacter in the pathogenesis of these diseases is not known.…”

“…For isolation of Helicobacter spp, tissue cultures and seeding of bile have been shown to be negative 8,10 , requiring the direct visualization of the bacillus in the histology using specific dyes such as modified Giemsa 13 , the use of immune-histochemical methods 14 or by PCR. Finding viable bacteria in the mucosa or in the bile of the gallbladder as Helicobacter spp and establishing a relationship with these changes as mucosal metaplasia and follicular cholecystitis, supported the works described above and open the possibilities to study the changes of biliary epithelial cell, related to the presence of the bacillus.…”