Association of H. pylori gastritis with Non-alcoholic Hepatic Steatosis in Patients - A Cross-Sectional Study in Tertiary Care Hospitals
DOI:
https://doi.org/10.53350/pjmhs02025194.5Keywords:
Helicobacter pylori, NAFLD, Dyspepsia, Liver Steatosis, Gastroenterology, ultrasonographyAbstract
Background: Helicobacter pylori is a common gastric pathogen that is more and more associated with systemic metabolic disorders. Obesity and insulin resistance are known as conditions that are associated with non-alcoholic hepatic steatosis, or liver fat.
Aim: The recent studies suggest the presence of possible correlation of H. pylori gastritis with hepatic fat accumulation.
Methodology: Between September to December 2024, this study was conducted in two tertiary care hospitals in Lahore, Pakistan. Upper gastrointestinal endoscopy and abdominal ultrasonography were performed in a total of 100 adult patients with dyspeptic symptoms. A diagnosis of H. pylori infection was confirmed by rapid urease test and histopathology of gastric biopsies and hepatic steatosis was diagnosed based on ultrasounds which were suggestive of a fatty liver. Those who had previously used alcohol, who had viral hepatitis or who had known liver diseases were excluded.
Results: Sixty two percent of enrolled patients (n=62) tested positive for H. pylori infection and 48 percent (n=48) had ultra-sonographic evidence of nonalcoholic hepatic steatosis. Of the 35 patients with H. pylori gastritis 56.4% showed concurrent hepatic steatosis as compared to 13 (30.9%) in H. pylori negative patients. This was a statistically significant association (p = 0.012). Patients with both conditions had elevated BMI and fasting blood glucose.
Conclusion: The association between H. pylori gastritis and nonalcoholic hepatic steatosis in dyspeptic patients was found in this study. These findings indicate a possibility of a chronic H. pylori infection having an extra-gastric metabolic influence. Longitudinal studies to explore the causal relationship and the underlying pathophysiological mechanisms are recommended further.
References
Mitchell H, Katelaris P. Epidemiology, clinical impacts and current clinical management of Helicobacter pylori infection. Med J Aust 2016; 10:376–380.
Sustmann A, Okuda M, Koletzko S. Helicobacter pylori in children. Helicobacter 2016; 21: 49-54.
Tapper EB, Parikh ND. Diagnosis and Management of Cirrhosis and Its Complications: A Review. JAMA. 2023;329(18):1589–1602.
Hooi J.K.Y., Lai W.Y., Ng W.K., Suen M.M.Y., Underwood F.E., Tanyingoh D., Malfertheiner P., Graham D.Y., Wong V.W.S., Wu J.C.Y., et al. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis. Gastroenterology. 2017;153:420–429.
World Gastroenterology O. World Gastroenterology Organisation Global Guideline: Helicobacter pylori in developing countries. J. Clin. Gastroenterol. 2011;45:383–388.
Burucoa C., Axon A. Epidemiology of Helicobacter pylori infection. Helicobacter. 2017;22(Suppl. 1).
32. Hunt R.H., Xiao S.D., Megraud F., Leon-Barua R., Bazzoli F., van der Merwe S., Vaz Coelho L.G., Fock M., Fedail S., Cohen H., et al. Helicobacter pylori in developing countries. World Gastroenterology Organisation Global Guideline. J. Gastrointest. Liver Dis. 2011;20:299–304.
Xia HX, Windle HJ, Marshall DG, Smyth CJ, Keane CT, O’Morain CA. Recrudescence of Helicobacter pylori after apparently successful eradication: novel application of randomly amplified polymorphic DNA fingerprinting. Gut [Internet]. 1995;37(1):30–4.
Singh V, Mishra S, Rao GRK, Jain AK, Dixit VK, Gulati AK, et al. Evaluation of nested PCR in detection of Helicobacter pylori targeting a highly conserved gene: HSP60: Nested PCR in detection of H. pylori. Helicobacter [Internet]. 2008;13(1):30–4.
ZulloA,RomilliA,RinaldiV,VecchioneA.Gastric epithelial cell proliferation in patients with liver cirrhosis.Dig Dis Sci 2001;46(3):550-4.
WalugaM,KuklaM,ZorniakM,BacikA,KotulskiR.From the stomach to other organs:Helicobacter pylori and the liver.World J Hepatol.(2015)7:2136-46.
Sun X, Xu Y, Wang L, Zhang F, Zhang J, Fu X, et al. Association between TNFA gene polymorphisms and Helicobacter pylori infection: a meta-analysis. PLoS One 2016; 1:e0147410.
Silva LD, Rocha AM, Rocha GA, de Moura SB, Rocha MM, Dani R, et al. The presence of Helicobacter pylori in the liver depends on the Th1, Th17 and Treg cytokine profile of the patient. Mem Inst Oswaldo Cruz 2011; 106:748–754.
Buzás GM. Metabolic consequences of Helicobacter pylori infection and eradication. World J Gastroenterol 2014; 18:5226–5234.
Abdel-Razik A, Mousa N, Shabana W, Refaey M, Elhelaly R, Elzehery R, et al. Helicobacter pylori and non-alcoholic fatty liver disease: a new enigma? Helicobacter. (2018) 23:e12537.
Queiroz DM, Rocha AM, Rocha GA, Cinque SM, Oliveira AG, Godoy A, Tanno H. Association between Helicobacter pylori infection and cirrhosis in patients with chronic hepatitis C virus. Dig Dis Sci. 2006 Feb;51(2):370-3.
Feng H, Zhou X, Zhang G. Association between cirrhosis and Helicobacter pylori infection: a meta-analysis. Eur J GastroenterolHepatol. 2014 Dec;26(12):1309-19.
Pogorzelska J, Łapińska M, Kalinowska A, Łapiński TW, Flisiak R. Helicobacter pylori infection among patients with liver cirrhosis. Eur J GastroenterolHepatol. 2017 Oct; 29(10):1161-1165.
Singh MP, Yadav KA, Singh B, Gautam A. Prevalance of H. Pylori Infection in Patients of Cirrhosis of Liver with Its Etiological Correlation. 2022 Feb; 10(02):60-7.
Xu G, Ma S, Dong L, Mendez-Sanchez N, Li H, Qi X. Relationship of Helicobacter pylori Infection with Nonalcoholic Fatty Liver Disease: A Meta-Analysis. Can J Gastroenterol Hepatol. 2023 Jan; 2023: 5521239.
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2025 MARYAM ASHRAF, MUHAMMAD ZAHID ALI RAZA, FAIZA ALTAF, MAIDA ANWAR, ARSALAN ASLAM CHAUDHARY, AAMIR SIDDIQUE
This work is licensed under a Creative Commons Attribution 4.0 International License.
