Does Helicobacter pylori-induced gastritis enhance food-stimulated insulin release?

The impact of Helicobacter pylori infection on gut microbiota-endocrine system axis; modulation of metabolic hormone levels and energy homeostasis

The gut microbiota is a complex ecosystem that is involved in the development and preservation of the immune system, energy homeostasis and nutritional status of the host. The crosstalk between gut microbiota and the host cells modulates host physiology and metabolism through different mechanisms. Helicobacter pylori (H. pylori) is known to reside in the gastric mucosa, induce inflammation, and alter both gastric and intestinal microbiota resulting in a broad spectrum of diseases, in particular metabolic syndrome-related disorders. Infection with H. pylori have been shown to affect production level and physiological regulation of the gut metabolic hormones such as ghrelin and leptin which are involved in food intake, energy expenditure and body mass. In this study, we reviewed and discussed data from the literature and follow-up investigations that links H. pylori infection to alterations of the gut microbiota and metabolic hormone levels, which can exert broad influences on host metabolism, energy homeostasis, behavior, appetite, growth, reproduction and immunity. Also, we discussed the strong potential of fecal microbiota transplantation (FMT) as an innovative and promising investigational treatment option for homeostasis of metabolic hormone levels to overcome H. pylori-associated metabolic syndrome-related disorders.

Sarcopenia and Sarcopenic Obesity as Novel Risk Factors for Gastric Carcinogenesis: A Health Checkup Cohort Study

Background: Insulin resistance, the primary mechanism of metabolic syndrome, promotes gastric carcinogenesis. Metabolic syndrome is associated with sarcopenia. We aimed to investigate the association between sarcopenia and gastric carcinogenesis, including precancerous conditions such as atrophic gastritis (AG), intestinal metaplasia (IM), and dysplasia.

Methods: The study included adult patients who underwent gastroduodenoscopy at a checkup center. AG and IM were evaluated using endoscopy. Based on muscle mass, sarcopenia was defined as a skeletal muscle index <1 standard deviation below the sex-specific mean for healthy adults aged 20–39 years (cutoff point: 29.3% for males and 26.7% for females). Obesity was defined as a body mass index (BMI) ≥25 kg/m² according to the Asia-Pacific criteria. Sarcopenic obesity was defined as a combination of sarcopenia and obesity. The association between gastric carcinogenesis and sarcopenia was evaluated.

Results: Among 8,356 enrolled participants, 0.14 and 42.5% were diagnosed with gastric cancer and precancerous conditions, respectively. Approximately 41.7% of gastric cancer patients and 16.9% of patients with precancerous conditions were diagnosed with sarcopenia. Both sarcopenic obesity (odds ratio [OR] = 4.139, P = 0.016) and diabetes mellitus (DM) (OR = 5.152, P = 0.005) were significantly associated with gastric cancer. Sarcopenia, DM, hypertension, dyslipidemia, Helicobacter pylori infection, smoking, and alcohol consumption were significantly associated with precancerous conditions.

Conclusions: Sarcopenia and sarcopenic obesity were associated with gastric carcinogenesis and may be novel risk factors for gastric carcinogenesis.

Long-term metformin use reduces gastric cancer risk in type 2 diabetics without insulin treatment: a nationwide cohort study

BACKGROUND

Metformin use has been associated with a decreased incidence and mortality of various cancers.

AIM

To evaluate the association between metformin use and gastric cancer.

METHODS

We randomly selected 100 000 type 2 diabetic patients from the 2004 Korean National Health Insurance claim database, and assessed gastric cancer incidence among 39 989 patients (aged 30-97 years) who were regularly treated with anti-diabetic drugs and followed-up from 2004 to 2010. In total, 26 690 patients had used metformin out of 32 978 diabetics who had not regularly used insulin (insulin non-users), and 5855 patients had used metformin out of 7011 regular insulin users.

RESULTS

Patients who used metformin showed a lower incidence of gastric cancer than those who did not use metformin, in insulin non-users (P = 0.047, log-rank test). However, in patients on regular insulin, there was no difference of gastric cancer incidence according to metformin use. In insulin non-users, the adjusted hazard ratio (AHR) for metformin use was 0.73 (95% confidential interval [CI], 0.53-1.01) with borderline statistical significance (P = 0.059). Duration of metformin use was associated with the reduction in gastric cancer risk (AHR, 0.88; 95% CI 0.81-0.96, P = 0.003), especially in patients who used metformin for more than 3 years (AHR, 0.57; 95% CI, 0.37-0.87; P = 0.009).

CONCLUSION

Metformin use >3 years in type 2 diabetics who do not use insulin is associated with a significantly reduced gastric cancer risk.

Increased risk of gastrointestinal malignancy in patients with diabetes mellitus and correlations with anti-diabetes drugs: a nationwide population-based study in Taiwan

OBJECTIVE

Although the major cause of morbidity and mortality in patients with diabetes mellitus (DM) is cardiovascular disease, DM is also associated with certain site-specific cancers. However, whether DM is associated with an increased risk of cancer of the digestive tract remains undetermined. A nationwide, population-based database in Taiwan was analyzed to explore the relationship between DM and cancer of the digestive organs.

METHODS

From 2000 to 2007, a study cohort consisting of 39,515 patients with newly diagnosed diabetes without a previous diagnosis of gastrointestinal (GI) cancer was identified from the National Health Insurance Research Database in Taiwan. A control cohort of 79,030 age- and sex-matched non-diabetic subjects was selected to compare the occurrence of GI malignancies between the two groups. The association between the incidence of GI cancers and the use of glucose-lowering therapies was also investigated.

RESULTS

During the 7-year follow-up period, GI cancers developed in 929 diabetic patients (2.35%) and 1,126 subjects (1.42%) in the comparison cohort. DM was associated with a 2.75-fold (95% confidence interval (CI), 2.51-3.02) higher risk of developing GI malignancy. Among GI cancers, the incidences of stomach (adjusted hazard ratio (HR), 1.49; 95% CI, 1.16-1.92), liver (adjusted HR, 2.65; 95% CI, 2.29-3.07), colon (adjusted HR, 1.58; 95% CI, 1.28-1.94) and pancreatic cancers (adjusted HR, 4.35; 95% CI, 2.93-6.47) were significantly increased in the patients with DM. An analysis of the effects of various glucose-lowering therapies in the diabetic patients revealed the use of α-glucosidase inhibitors to be associated with a lower risk of hepatic cancer (adjusted HR, 0.62; 95% CI, 0.4-0.94). Thiazolidinedione (TZD) treatment was associated with lower stomach (adjusted HR, 0.11; 95% CI, 0.02-0.82) and hepatic cancer risks (adjusted HR, 0.46; 95% CI, 0.29-0.73), while sulfonylurea use was associated with a lower colon cancer risk (adjusted HR, 0.74; 95% CI, 0.51-1.09) and a higher pancreatic cancer risk (adjusted HR, 2.36; 95% CI, 1.21-4.61).

CONCLUSION

Patients with DM have an increased risk of GI malignancy that may be affected by the use of different categories of glucose-lowering therapies.

Diabetes mellitus and gastric carcinoma: Is there an association?

Diabetes mellitus (DM) has been associated with the risk of several gastrointestinal cancers including liver, pancreas, colon and rectum. However, the evidence is inconclusive for gastric adenocarcinoma (GC). In the current review, we summarize 20 population-based cohort studies that compared GC incidence and mortality between diabetic and non-diabetic population. We discuss the shared risk factors and provide qualitative and quantitative (meta-analytic) summary of the current evidence evaluating the association by high-risk subgroups. The overall risk-estimate based on all studies did not show an increased risk of GC in diabetics. However, 2 cohort studies conducted in East Asian countries, where Helicobacter pylori infection and GC rates are higher, showed a higher risk of GC in diabetics. Additionally, high plasma glucose levels in the presence of Helicobacter pylori infection increased the risk of GC by over four times, suggesting a multiplicative effect. Results from the meta-analysis show that, the risk of GC was also higher in populations with greater prevalence of type 1 DM (relative risk = 1.60), suggesting an insulin-independent carcinogenic process in this subgroup. The risk of mortality due to GC was higher in diabetics compared to non-diabetics (relative risk = 1.62). Although the overall risk estimates do not show an association between DM and GC, complex interactions between infectious, molecular, demographic and host factors may convey a higher risk in certain subgroups. Future studies should be sufficiently powered for detailed subgroup analysis to elucidate the causative and mechanistic association between DM and GC.

Type 2 diabetes mellitus: A risk factor for Helicobacter pylori infection: A hospital based case-control study

OBJECTIVE

To determine the frequency of Helicobacter pylori (H. pylori) infection in diabetic and non-diabetic patients and to compare the frequency of H. pylori infection in both groups.

STUDY DESIGN

Case control.

PLACE AND DURATION

Department of Medicine, Liaquat University Hospital from October 2007 to March 2008.

MATERIALS AND METHODS

This hospital-based case-control study was conducted on 148 subjects and divided into two groups i.e. type 2 diabetics and non-diabetics; each group consisting of 74 patients. All diabetic patients of >/= 35 years of age, both gender and the known cases with history of dyspepsia, epigastric pain or bloating for more than a month were screened for Helicobacter pylori infection. The collected data of both groups was evaluated and separated for analysis.

RESULTS

Majority of the patients were male with mean age +/- SD, 52.86 +/- 8.51. Among the diabetic group, HpSA was positive in 54/74 (73%), whereas in the non-diabetic group HpSA was positive in 38/74 (51.4%) cases. Fasting blood glucose was identified as low in 04 (5.40%) H. pylori infected - diabetic patients where as the blood glucose level of 07 (9.45%) known diabetic patients was raised despite the ongoing medication.

CONCLUSION

Diabetic patients are more prone and at risk to acquire H. Pylori infection. Therefore proper monitoring of blood glucose level and screening for H. pylori infection are effective preventive measures for this life threatening infection.

Type 2 diabetes mellitus: A risk factor for Helicobacter pylori infection: A hospital based case-control study

Objective:

To determine the frequency of Helicobacter pylori (H. pylori) infection in diabetic and non-diabetic patients and to compare the frequency of H. pylori infection in both groups.

Study Design:

Case control.

Place and Duration:

Department of Medicine, Liaquat University Hospital from October 2007 to March 2008.

Materials and Methods:

This hospital-based case-control study was conducted on 148 subjects and divided into two groups i.e. type 2 diabetics and non-diabetics; each group consisting of 74 patients. All diabetic patients of ≥ 35 years of age, both gender and the known cases with history of dyspepsia, epigastric pain or bloating for more than a month were screened for Helicobacter pylori infection. The collected data of both groups was evaluated and separated for analysis.

Results:

Majority of the patients were male with mean age ± SD, 52.86 ± 8.51. Among the diabetic group, HpSA was positive in 54/74 (73%), whereas in the non-diabetic group HpSA was positive in 38/74 (51.4%) cases. Fasting blood glucose was identified as low in 04 (5.40%) H. pylori infected - diabetic patients where as the blood glucose level of 07 (9.45%) known diabetic patients was raised despite the ongoing medication.

Conclusion:

Diabetic patients are more prone and at risk to acquire H. Pylori infection. Therefore proper monitoring of blood glucose level and screening for H. pylori infection are effective preventive measures for this life threatening infection.

Prospective study of self-reported diabetes and risk of upper gastrointestinal cancers

BACKGROUND

Although gastric noncardia adenocarcinoma (GNCA) incidence rates in the United States have decreased, the rates of gastric cardia adenocarcinoma (GCA) and esophageal adenocarcinoma (EADC) have increased. Obesity increases the risks of GCA and EADC, and the associations may be partially mediated by insulin resistance. A few case-control studies have shown an association between diabetes and an increased risk of EADC.

METHODS

We prospectively examined the association between diabetes and upper gastrointestinal (UGI) cancers in a cohort of 469,448 people in the United States, ages 50 to 71 at baseline. Cox proportional hazards regression was used to estimate the HR and 95% CI for diabetes and UGI cancers, controlling for multiple potential confounders, including body mass index (BMI).

RESULTS

We observed no association of self-reported diabetes with risk of EADC, HR (95% CI) = 0.98 (0.73-1.31), esophageal squamous cell carcinoma (ESCC), HR (95% CI) = 1.02 (0.60-1.74), or GNCA, HR (95% CI) = 0.98 (0.70-1.37). However, diabetes was significantly associated with an increased risk of GCA, HR (95% CI) = 1.89 (1.43-2.50). The significant association between diabetes and risk of GCA remained after adjustment for BMI, HR (95% CI) = 1.70 (1.28-2.26) and did not differ by BMI strata (P(interaction) = 0.83). The significant association was unchanged when restricting to only overweight subjects (BMI 25 to ≤30), HR (95% CI) = 1.83 (1.18-2.85).

CONCLUSIONS

We found a significant association between self-reported diabetes and increased risk of GCA.

IMPACT

Our results suggest that the metabolic and hormonal changes related to diabetes may play a role in the etiology of GCA independently from BMI.

Hyperglycemia increases risk of gastric cancer posed by Helicobacter pylori infection: a population-based cohort study

BACKGROUND & AIMS

Although diabetes mellitus and hyperglycemia are considered to be possible risk factors for various types of malignancy, the epidemiologic evidence concerning gastric cancer is scarce. The aim of this study was to evaluate the impact of hemoglobin A1c (HbA1c) levels on gastric cancer occurrence and their interaction with Helicobacter pylori infection.

METHODS

A total of 2603 Japanese subjects aged>or=40 years were stratified into 4 groups according to baseline HbA1c levels (<or=4.9%, 5.0%-5.9%, 6.0%-6.9%, and >or=7.0%) and followed up prospectively for 14 years.

RESULTS

During the follow-up, 97 subjects developed gastric cancer. The age- and sex-adjusted incidence of gastric cancer significantly increased in the 6.0%-6.9% (5.1 per 1000 person-years; P<.05) and >or=7.0% groups (5.5 per 1000 person-years; P<.05) compared with the 5.0%-5.9% group (2.5 per 1000 person-years), whereas it was slightly but not significantly high in the <or=4.9% group (3.6 per 1000 person-years). This association remained substantially unchanged even after adjusting for the confounding factors including Helicobacter pylori seropositivity, (multivariate-adjusted hazard ratio [HR], 2.13; 95% confidence interval [CI]: 1.30-3.47 for the 6.0%-6.9% group and HR, 2.69; 95% CI: 1.24-5.85 for the >or=7.0% group). Among subjects who had both high HbA1c levels (>or=6.0%) and Helicobacter pylori infection, the risk of gastric cancer was dramatically elevated (interaction term, P=.004).

CONCLUSIONS

Our findings suggest that casual hyperglycemia is a risk factor for gastric cancer and is a possible cofactor increasing the risk posed by Helicobacter pylori infection.

Insulin resistance in children with Helicobacter pylori infection

We aimed at investigating insulin resistance in children with Helicobacter pylori (H. pylori) infection. Fasting serum insulin and glucose levels were determined in 31 children with H. pylori (+) (H. pylori-infected group, 20 girls and 11 boys, median age 12 yr, range 6-17) and 29 H. pylori (-) (control group, 18 girls and 11 boys, median age 13 yr, range 5-16). Insulin resistance was assessed using homeostasis model assessment of insulin resistance (HOMA-IR) score. Fasting serum glucose levels did not differ significantly between H. pylori (+) and (-) children. Both HOMA-IR score and serum insulin levels were significantly higher in H. pylori-infected compared to control children. The findings of the present study suggested that there is a certain relation between H. pylori infection and insulin resistance in children.

Insulin resistance in H pylori infection and its association with oxidative stress

AIM: To determine the insulin resistance (IR) and oxidative status in H pylori infection and to find out if there is any relationship between these parameters and insulin resistance.

METHODS: Fifty-five H pylori positive and 48 H pylori negative patients were enrolled. The homeostasis model assessment (HOMA) was used to assess insulin resistance. Serum total antioxidant capacity (TAC), total oxidant status (TOS) and oxidative stress index (OSI) were determined in all subjects.

RESULTS: The total antioxidant capacity was significantly lower in H pylori positive group than in H pylori negative group (1.36 ± 0.33 and 1.70 ± 0.50, respectively; P < 0.001), while the total oxidant status and oxidative stress index were significantly higher in H pylori positive group than in H pylori negative group (6.79 ± 3.40 and 5.08 ± 0.95, and 5.42 ± 3.40 and 3.10 ± 0.92, respectively; P < 0.001). Insulin resistance was significantly higher in H pylori positive group than in H pylori negative group (6.92 ± 3.86 and 3.61 ± 1.67, respectively; P < 0.001). Insulin resistance was found to be significantly correlated with total antioxidant capacity (r = -0.251, P < 0.05), total oxidant status (r = 0.365, P < 0.05), and oxidative stress index (r = 0.267, P < 0.05).

CONCLUSION: Insulin resistance seems to be associated with increased oxidative stress in H pylori infection. Further studies are needed to clarify the mechanisms underlying this association and elucidate the effect of adding antioxidant vitamins to H pylori eradication therapy on insulin resistance during H pylori infection.

The effect of Helicobacter pylori on insulin resistance

Helicobacter pylori causes a lifelong infection in the stomach after exposure. H. pylorihas been shown to be associated with peptic ulcer and gastric cancer development. Moreover, it is held responsible for some other nongastric diseases. Among them, coronary heart disease attracts much debate. Many studies have demonstrated a close relationship between insulin resistance and atherosclerosis. Chronic inflammation and alterations in counter-regulatory hormones are deemed responsible for the etiology of insulin resistance. We aimed to examine the effect of H. pylori on insulin resistance. Sixty-three patients were enrolled in the study. Patients were divided into two groups according to H. pylori presence. HOMA-IR (homeostasis model assessment of insulin resistance) level was used to assess insülin resistance. Thirty-six patients were H. pylori positive and 27 were H. pylori negative. There was no difference between the two groups with regard to age, gender, or body mass index. HOMA-IR level was 1.73+/- 1.1 in the H. pylori-negative group, whereas it was 2.56 +/- 1.54 in the H. pylori-positive group (P < 0.05). This study provides the first direct evidence for an association between chronic H. pylori infection and insulin resistance.

Impact of fasting plasma glucose levels on gastric cancer incidence in a general Japanese population: the Hisayama study

OBJECTIVE

Several studies have shown associations between diabetes and various types of cancer other than gastric cancer. The aim of this cohort study was to evaluate the impact of fasting plasma glucose (FPG) levels on gastric cancer occurrence.

RESEARCH DESIGN AND METHODS

A total of 2,466 Japanese subjects aged > or =40 years were stratified into three groups according to FPG tertiles (<5.3 mmol/l, low FPG; 5.3-5.8 mmol/l, modest FPG; >5.8 mmol/l, high FPG) and followed up prospectively for 9 years.

RESULTS

During the follow-up, 66 subjects experienced gastric cancer. In men, the age-adjusted incidences were significantly higher in the modest-FPG (7.0 per 1,000 person-years, P < 0.05) and high-FPG (7.2, P < 0.05) groups than in the low-FPG group (2.2). In women, the high-FPG group also had a significantly higher age-adjusted incidence of gastric cancer compared with the low-FPG group (2.5 vs. 0.8, P < 0.05). The multivariate analysis with Cox's proportional hazards model revealed that the risks of gastric cancer in the modest-FPG (relative risk [RR] 2.3 [95% CI 1.1-5.0]) and high-FPG (3.1 [1.5-6.4]) groups were significantly higher than that in the low-FPG group, even after adjusting for other comprehensive risk factors, including Helicobacter pylori status, smoking, and dietary factors. However, this FPG-cancer association was observed only among H. pylori-seropositive subjects.

CONCLUSIONS

Our findings suggest that a modest increase in FPG is a risk factor for gastric cancer and that hyperglycemia is a possible cofactor increasing the risk posed by Helicobacter pylori infection.

Helicobacter pylori infection and fasting plasma glucose concentration

BACKGROUND

Helicobacter pylori infection raises basal and meal stimulated serum gastrin concentrations and lowers iron stores, which may in turn reduce fasting plasma glucose concentrations in the population.

AIM

To determine whether H pylori infection leads to lower fasting plasma glucose concentrations in the population.

METHODS

One hundred and seventy three women and 165 men, randomly selected from the electoral rolls of an Australian city, participated in a cardiovascular risk factor survey. Plasma glucose concentrations and H pylori IgG antibody titres were measured. Non-fasting subjects and pregnant women were excluded, as were known diabetics, whose plasma glucose concentrations would be affected by diet and/or medications. Fasting plasma glucose concentrations were logarithmically transformed and the relation with H pylori infection, adjusting for age and other confounding factors, was determined for men and women separately by analyses of variance.

RESULTS

Helicobacter pylori infection was significantly associated with fasting plasma glucose concentration among women. Infected women had a lower mean fasting plasma glucose concentration (5.2 mmol/litre; range, 3.9-8.2) than did non-infected women (5.4 mmol/litre; range, 3.9-11.1).

CONCLUSIONS

Helicobacter pylori infection may lead to lower fasting plasma glucose concentrations among women and should be considered when interpreting concentrations bordering on diabetes.