Vitamin D deficiency and risk of Helicobacter pylori infection in older adults: a cross-sectional study

Recent Advances in Vitamin D3 Intervention to Eradicate Helicobacter pylori Infection

Helicobacter pylori (HP) infections affect approximately one-third of children worldwide. In China, the incidence of HP infection in children ranges from approximately 30% to 60%. In addition to damaging the gastrointestinal tract mucosa, HP infection in children can negatively affect their growth and development, hematology, respiratory and hepatobiliary system, skin, nutritional metabolism, and autoimmune system. However, the rate of HP eradication also fell considerably from the previous rate due to the presence of drug-resistant HP strains and the limited types of antibiotics that can be used in young patients. Vitamin D3 (VitD3) is a steroid hormone that can reduce inflammation in the stomach mucosa induced by HP and can alleviate and eradicate HP through a variety of pathways and mechanisms, including immune regulation and the stimulation of antimicrobial peptide (AMP) secretion and Ca2+ influx, to reestablish lysosomal acidification; thus, these results provide new strategies and ideas for the eradication of drug-resistant HP strains.

Association of serum vitamin D levels on Helicobacter pylori infection: a retrospective study with real-world data

OBJECTIVE

The aim of this study was to determine whether serum vitamin D levels are associated with H. pylori infection and whether low serum vitamin D levels are an independent risk factor for H. pylori infection.

METHODS

We conducted a retrospective analysis of a multicenter cohort study from 2017 to 2019. A total of 415 H. pylori+ patients and 257 H. pylori- patients aged between 18 and 75 years with both 13 C-urea breath test and serum vitamin D level results were included from four hospitals. A questionnaire was used to collect information on potential factors influencing H. pylori infection.

RESULTS

Serum vitamin D levels were significantly lower in the H. pylori+ group than in the H. pylori- group (16.7 ± 6.6 ng/ml vs. 19.2 ± 8.0 ng/ml, p < 0.05). Using a cutoff value of 20 ng/ml, the H. pylori infection rate was significantly higher in the vitamin D-deficient group (< 20 ng/ml) than in the vitamin D-nondeficiency group (≥ 20 ng/ml) (66.5% vs. 51.0%, p < 0.001). Ordered logistic regression analysis showed that serum vitamin D levels < 20 ng/ml (OR: 1.652, 95% CI: 1.160-2.351, p = 0.005), higher education levels (OR: 1.774, 95% CI: 1.483-2.119, p < 0.001), family size ≥ 4 (OR: 1.516, 95% CI: 1.081-2.123, p = 0.016), and lower annual income (OR: 1.508, 95% CI: 1.289-1.766, p < 0.001) were independent risk factors for H. pylori infection.

CONCLUSION

Lower serum vitamin D levels may be associated with an increased risk of H. pylori infection, and lower serum vitamin D levels are an independent risk factor for increasing H. pylori infection rates. Randomized controlled trials are needed to determine whether supplementation with vitamin D can reduce H. pylori infection rates.

Vitamin D and Its Association with H. pylori Prevalence and Eradication: A Comprehensive Review

Taking into account previous data that sustain a relationship between vitamin D deficiency and higher H. pylori infection positivity rates, this review aims to assess the influence of vitamin D deficiency and/or insufficiency upon the prevalence of H. pylori infection and its eradication success. Three major databases were searched for articles that analyzed a relationship between vitamin D status and H. pylori infection. The literature search retrieved a total of 37 reports, after the article selection process. Hypovitaminosis D emerged as a potential risk factor for H. pylori infection, given the higher prevalence of vitamin D deficiency and/or insufficiency among H. pylori-positive subjects. Furthermore, the same type of micronutrient deficiency has been directly linked to H. pylori eradication failure. An inverse linear relationship between vitamin D status and gastric cancer risk exists, but the additional involvement of H. pylori in this correlation is still in question. The potential benefit of oral supplements in enhancing the success of classical therapeutic regimens of H. pylori still requires future research. Future population-based studies from larger geographical areas are warranted to address this subject in more depth.

25-hydroxyvitamin D levels in children of different ages and with varying degrees of Helicobacter pylori infection and immunological features

Background

Helicobacter pylori (HP) is a major cause of upper digestive tract diseases. However, the relationship between HP infection and 25-hydroxyvitamin D [25(OH)D] levels in children has not been fully elucidated. This study investigated the levels of 25(OH)D in children of different ages and with varying degrees of HP infection and immunological features as well as the correlations between 25(OH)D levels in children infected with HP and their ages and degrees of infection.

Materials and methods

Ninety-four children who underwent upper digestive endoscopy were divided into an HP-positive group without peptic ulcers (Group A), an HP-positive group with peptic ulcers (Group B) and an HP-negative control group (Group C). The serum levels of 25(OH)D and immunoglobulin and the percentages of lymphocyte subsets were determined. HP colonization, the degree of inflammation, and the degree of activity were further evaluated by HE staining and immunohistochemical staining in gastric mucosal biopsy.

Results

The 25(OH)D level of the HP-positive groups (50.93 ± 16.51 nmol/L) was significantly lower than that of the HP-negative group (62.89 ± 19.18 nmol/L). The 25(OH)D level of Group B (47.79 ± 14.79 nmol/L) was lower than that of Group A (51.53 ± 17.05 nmol/L) and was significantly lower than that of Group C (62.89 ± 19.18 nmol/L). The 25(OH)D level decreased with increasing age, and there was a significant difference between Group C subjects who were ≤5 years old and those who were aged 6-9 years and ≥10 years. The 25(OH)D level was negatively correlated with HP colonization (r = -0.411, P < 0.01) and the degree of inflammation (r = -0.456, P < 0.01). The percentages of lymphocyte subsets and immunoglobulin levels among Groups A, B and C were not significantly different.

Conclusions

The 25(OH)D level was negatively correlated with HP colonization and the degree of inflammation. As the age of the children increased, the level of 25(OH)D decreased, and the susceptibility to HP infection increased.

Association between Dietary Habits and Helicobacter pylori Infection among Bahraini Adults

Helicobacter pylori (H. Pylori) infection is the main bacterial cause of several gastrointestinal disorders. This study aims to estimate the prevalence of H. pylori infection in a population of Bahraini adults seeking care in gastroenterology clinics in a tertiary care hospital in the Kingdom of Bahrain and examine the association between dietary habits and other factors with H. pylori infection. The study is a hospital-based retrospective, cross-sectional analytical study that included 200 participants. H. pylori infection prevalence among the studied group was 55.5%, and it was significantly higher among participants with a high school education or less (44.1%). Among dietary habits, the mean of frequency of green tea, coffee and honey intake was significantly lower among the H. pylori infected participants compared to their non-infected counterparts. H. pylori infection was significantly higher among participants with vitamin D deficiency (63.6%) compared to participants with normal vitamin D (30%) (p = 0.001) and each unit decrease in serum vitamin D was associated with an increased risk of infection by 1.1 times (OR = 1.1; 95% CI: 1.05, 1.18; p < 0.001). The study revealed that high educational levels, consumption of honey, green tea, and coffee, as well as normal serum vitamin D level, were independent protectors against H. pylori infection. Additional studies are needed to estimate the prevalence and predisposing factors of H. pylori infection in the general population.

Association between serum vitamin D levels and Helicobacter pylori cytotoxic-associated gene A seropositivity: a cross-sectional study in US adults from NHANES III

OBJECTIVE

To assess the association of serum vitamin D (VD) levels and Helicobacter pylori (H. pylori) cytotoxic-associated gene A (CagA) seropositivity, and further explore potential effect modifiers in this association.

DESIGN

Cross-sectional study.

SETTING

Data from phase I of the National Health and Nutrition Examination Survey (NHANES III, 1988-1991) led by the Center for Disease Control and Prevention.

PARTICIPANTS

A total of 3512 US adults (≥20 years) with both serum VD levels and H. pylori CagA antibody data from NHANES III were included in the analysis.

METHODS

VD deficiency was defined as serum 25(OH)D concentrations<20 ng/mL. Logistic regression models were used to assess the association of serum VD levels and H. pylori CagA seropositivity (VD-Hp CagA+), and stratification analyses were used to explore potential effect modifiers.

RESULTS

There was no significant association of VD-Hp CagA+ in the general population. But serum 25(OH)D concentrations were associated with H. pylori CagA+ in non-Hispanic whites (adjusted OR=1.02, 95% CI: 1.00 to 1.03), other races/ethnicities (adjusted OR=1.08, 95% CI: 1.01 to 1.06), populations born in other countries (adjusted OR=1.09, 95% CI: 1.04 to 1.15) or occasional drinkers (adjusted OR=0.93, 95% CI: 0.88 to 0.99). VD deficiency was associated with H. pylori CagA+ in non-Hispanic whites (adjusted OR=0.69, 95% CI: 0.53 to 0.92), populations born in other countries (adjusted OR=0.47, 95% CI: 0.25 to 0.89), non-drinkers (adjusted OR=0.80, 95% CI: 0.65 to 0.99), occasional drinkers (adjusted OR=2.53, 95% CI: 1.06 to 6.05), population with first quartile level of serum ferritin (adjusted OR=0.70, 95% CI: 0.51 to 0.96) or fourth quartile level of serum folate (adjusted OR=0.63, 95% CI: 0.46 to 0.87).

CONCLUSIONS

Racial/ethnic differences and different serum ferritin or serum folate levels may be effect modifiers for the association of VD-Hp CagA+.

Vitamins and Helicobacter pylori: An Updated Comprehensive Meta-Analysis and Systematic Review

Background

Over recent decades, epidemiological studies have shown relationships between vitamins and Helicobacter pylori (H. pylori) infection and eradication, but the results are controversial.

Methods

A comprehensive meta-analysis and systematic review were conducted to clarify the relationships between common types of vitamins and H. pylori. We applied meta-regression, subgroup analysis and sensitivity analysis to obtain available evidence. Articles published from January 1991 to June 2021 in PubMed, EMBASE, and the Cochrane Library were searched.

Results

In total, we identified 48 studies. The results indicate that H. pylori -positive patients had lower serum vitamin B₁₂ [standardized mean difference (SMD) = −0.30; 95% confidence interval (CI): −0.53 – −0.08], folate (SMD = −0.69; 95% CI: −1.34 – −0.04), vitamin C (SMD = −0.37; 95%CI: −0.57 – −0.18) and vitamin D (SMD = −0.34; 95% CI: −0.49 – −0.18) levels than H. pylori-negative patients. Patients in which H. pylori had been successfully eradicated had higher serum vitamin D levels (SMD = 1.37; 95% CI: 0.37–2.38) than in patients in which eradication had been unsuccessful. The serum vitamin B₁₂ levels of H. pylori-positive patients improved after successful H. pylori eradication therapy (SMD = 1.85; 95% CI: 0.81–2.90), and antioxidant vitamin supplementation to an H. pylori eradication regimen improved the eradication rate (risk ratio = 1.22; 95% CI: 1.02–1.44 for per-protocol analysis; risk ratio = 1.25; 95% CI: 1.06–1.47 for intention-to-treat analysis).

Conclusions

H. pylori infections decrease the serum levels of several types of vitamins, eradication of H. pylori could rescue its adverse effects, and antioxidant vitamin supplementation may improve the H. pylori eradication rate.

Systematic Review Registration

identifier: CRD42021268127.

Assessment of Serum Vitamin D Levels in the serum of Patients with Postherpetic neuralgia and its correlation to pain severity: A cross-sectional comparative study

INTRODUCTION

Vitamin D is an essential micronutrient for the maintenance of many functions in the human body. Postherpetic neuralgia (PHN) is caused by the reactivation of the latent varicella-zoster virus (VZV) in the neurons. This study aims to assess the serum vitamin D level in patients with PHN and to correlate the level of vitamin D with pain severity.

METHODS AND MATERIALS

A hospital-based cross-sectional comparative study was conducted in the period from April 2019 to January 2021. One hundred and sixty-two individuals, matched for age and gender, divided into cases and controls (81 for each). Serum levels of 25(OH)D were measured for cases and controls. Demographic data were taken, and then the diagnosis of neuropathic pain in cases was established using the Douleur Neuropathique 4 (DN4) questionnaire.

RESULTS

We included 39 (52%) males in the PHN group and 36 (48%) in the control group. There was no significant difference between groups regarding age, marital status, smoking and BMI. The duration of pain in our study had a mean of 7.6 ± 3.6 months. We found the DN4 score for the pain to be negatively associated with vitamin D levels (Pearson's correlation coefficient: -0.511, P = .000). The levels of vitamin D were moderately associated with pain duration (Pearson's correlation: -0.466, P = .000).

CONCLUSION

PHN patients had a high prevalence of vitamin D deficiency and those who had vitamin D deficiency were older and had higher degrees of pain for a longer duration. In PHN patients, vitamin D deficiency was moderately associated with increased severity and duration of pain.

The association between gastric bacterial infection and low level of vitamin D among patients with type 2 diabetes mellitus

Objectives: The present research aimed to find an association between infection by Helicobacter pylori and vitamin D deficiency in type 2 diabetic Iraqis attending Al-Yarmouk Teaching Hospital. Methods: According to fasting blood glucose, the samples were divided into a non-diabetic group with ten diabetic individuals and a diabetic group with thirty individuals. Results: The anti-H. pylori (IgG) levels were 86.77±58.62 NTU/μL in diabetic patients compared with 10.12_7.40 NTU/μL in non-diabetic group. Vitamin D levels were decreased significantly in infected patients compared to non-infected subjects. Conclusion: The H. pylori-infected patients have recorded the lowest level of vitamin D than non-infected individuals.

The Association between Serum Vitamin D Levels and Helicobacter pylori Presence and Eradication

Background: The success of Helicobacter pylori (H. pylori) eradication depends on several host and treatment factors. Serum vitamin D levels may be associated with H. pylori infection and eradication rates. We investigated the association between vitamin D and H. pylori infection and eradication, using a large electronic database based on medical records from a population-based health maintenance organization. Methods: Data regarding adults who underwent H. pylori testing and had vitamin D measurements within one month of H. pylori testing were collected. H. pylori infection was ascertained using urea breath or stool antigen tests. A negative H. pylori test following a positive result implied eradication. Multivariate regression models were constructed to assess associations between H. pylori infection, eradication, and vitamin D. Results: Among 150,483 members who underwent H. pylori testing from 2009 to 2018, 27,077 (18%) had vitamin D measurements. Vitamin D levels were inversely associated with H. pylori infection, p < 0.001. The odds of a positive H. pylori test were 31% higher among patients with vitamin D levels <20 ng/mL, compared with those with levels ≥20 ng/mL (OR 1.31, 99% CI 1.22–1.4, p < 0.001). Purchase of vitamin D supplements was associated with a negative subsequent H. pylori test (p < 0.001). Mean vitamin D levels were moderately higher in those with successful vs. failed H. pylori eradication (19.34 ± 9.55 vs. 18.64 ± 9.61, p < 0.001). Conclusions: Vitamin D levels are associated with H. pylori infection. Increased vitamin D levels are associated with successful H. pylori eradication. Vitamin D may have a role in H. pylori eradication.

Analysis of Eradication, Recurrence and Levels of 25-hydroxyvitamin D3 and Interleukin-1β in paediatric patients with Helicobacter Pylori Infection-related Gastritis

Objective:

To study whether the levels of 25-hydroxyvitamin D₃ (25-(OH)D₃) and Interleukin-1β (IL-1β) are correlated to the eradication and recurrence of helicobacter pylori (Hp) in paediatric patients with Hp infection-related gastritis.

Methods:

A total of 142 paediatric patients with Hp infection-related gastritis from November 2017 to March 2018 in Baoding Children’s Hospital were selected as study subjectswere selected as study subjects and were followed up for one year. Paediatric patients were grouped and analyzed according to the effect of follow-up treatment and recurrence.

Results:

The levels of 25-(OH) D₃ in the non-eradication group were lower than those in the eradication group and the control group (F=27.087, P<0.05); the levels of IL-1β were higher than those in the eradication group and the control group (F=16.610, P<0.05). Recurrence during follow-up visits: The levels of 25-(OH) D₃ in the recurrence group were lower than those in the non-recurrence group and the control group (F=33.837, P<0.05); the levels of IL-1β in the recurrence group were higher than those in the non-recurrence group and the control group (F=7.896, P<0.05). Correlation analysis showed the levels of 25-(OH) D₃ and IL-1β in the eradication group and the non-eradication group were negatively correlated (r=-0.232, P<0.05); the levels of 25-(OH) D₃ and IL-1β in the recurrence group and the non-recurrence group were negatively correlated (r=-0.225, P<0.05).

Conclusion:

Relatively high levels of IL-1β may be correlated to the difficulty in eradicating the Hp infection in paediatric patients. Relatively low levels of 25-(OH) D₃ may be correlated to the difficulty in eradicating the Hp infection and recurrence in paediatric patients.

Relationship Between Helicobacter pylori Infection, Serum Vitamin D3 Level and Spontaneous Abortion

Background

The effects of vitamin D3 (VD3) on pregnancy outcomes remain obscure. Thus, this study aims to investigate the relationship between maternal H. pylori infection, low VD3 level, and spontaneous abortion.

Methods

This research is conducted in Shahid Ali Qader Consultant Clinic in Sulaimaniyah city in which 100 women with a history of abortion and 100 women with no history of miscarriage were included. Serum detection of anti-H. pyloriIgG, IgA, and VD3 were done using enzyme-linked immunosorbent assay (ELISA) technique.

Results

The mean of VD3, H. pylori IgG, and IgAin patients and control group cases was determined and analyzed statistically.

Conclusion

H. pylori infection and VD3 play a significant role in early pregnancy loss. Blood group A and O are more prone to spontaneous abortion.

Role of Helicobacter pylori infection in the manifestation of old age-related diseases

Helicobacter pylori is one of the most prevalent infection worldwide. It affects individuals of different age groups. Elderly people tend to resist eradication treatment and worsening of infection can lead to several gastric and non-gastric pathologies. Aging-associated cellular and molecular alteration can increase the risk of other pathologies such as osteoporosis, Alzheimer's disease, Parkinson's disease, respiratory and renal dysfunction, and cancer in geriatric patients, more than other age groups. This review article highlights some of the most common old age diseases and the role of H. pylori infection as a risk factor to worsen the conditions, presented by the molecular evidences of these associations. These studies can help clinicians to understand the underlying pathogenesis of the disease and identify high-risk patients, aiding clearer diagnosis and treatment.

Recent progress in Helicobacter pylori treatment

The main challenge in the field of Helicobacter pylori (H. pylori) infection is antibiotic resistance, which influences the efficacy of eradication regimens. Bismuth-containing quadruple therapy has been confirmed as an effective regimen for eradicating H. pylori, especially in strains with antibiotic resistance. High-dose proton-pump inhibitor-amoxicillin dual therapy could decrease the use of unnecessary antibiotics, which is a promising alternative approach. Adjuvant therapy (specific probiotic or vitamin) also showed good results, although more evidence is needed. Novel anti-H. pylori drugs are needed, and the establishment of the H. pylori database is an effective way to acknowledge the real-time information of H. pylori management. This review provides the recent progress of H. pylori treatment, and further studies are needed to address the role of different regimens in improving H. pylori eradication rate, especially in strains with antibiotics resistance.

Hypovitaminosis Din Postherpetic Neuralgia-High Prevalence and Inverse Association with Pain: A Retrospective Study

Hypovitaminosis D (25-hydroxyvitamin D (25(OH)D) <75 nmol/L) is associated with neuropathic pain and varicella-zoster virus (VZV) immunity. A two-part retrospective hospital-based study was conducted. Part I (a case-control study): To investigate the prevalence and risk of hypovitaminosis D in postherpetic neuralgia (PHN) patients compared to those in gender/index-month/age-auto matched controls who underwent health examinations. Patients aged ≥50 years were automatically selected by ICD-9 codes for shingle/PHN. Charts were reviewed. Part II (a cross-sectional study): To determine associations between 25(OH)D, VZV IgG/M, pain and items in the DN4 questionnaire at the first pain clinic visit of patients. Independent predictors of PHN were presented as adjusted odds ratios(AOR) and 95% confidence intervals (CI). Prevalence (73.9%) of hypovitaminosis D in 88 patients was high. In conditional logistic regressions, independent predictors for PHN were hypovitaminosis D (AOR3.12, 95% CI1.73–5.61), malignancy (AOR3.21, 95% CI 1.38–7.48) and Helicobacter pylori-related peptic ulcer disease (AOR3.47, 95% CI 1.71–7.03). 25(OH)D was inversely correlated to spontaneous/brush-evoked pain. Spontaneous pain was positively correlated to VZV IgM. Based on the receiver operator characteristic curve, cutoffs for 25(OH)D to predict spontaneous and brush-evoked pain were 67.0 and 169.0 nmol/L, respectively. A prospective, longitudinal study is needed to elucidate the findings.

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

BACKGROUND

Various studies reported the relationship between Helicobacter pylori (H pylori) and vitamin D, but there is some controversy around that. This study aimed to conduct a meta-analysis to clarify the relationship between vitamin D and H pylori infection, and vitamin D and H pylori eradication.

METHODS

Articles published until June 1, 2019, in the PubMed, MEDLINE, and EMBASE databases with English-language medical studies were searched. According to the inclusion criteria, relevant statistical data were extracted to Microsoft Excel and analyzed by STATA15.1.

RESULTS

Ten articles were finally included. It was demonstrated that average 25(OH)D level in H pylori-positive patients was lower than H pylori-negative (SMD = -0.53 ng/mL, 95% CI = (-0.91, -0.16 ng/mL)). For H pylori eradication individuals, the result showed that average 25(OH)D level in H pylori successful eradication individuals was higher than unsuccessful (SMD = 1.31 ng/mL, 95% CI = [0.60, 2.02 ng/mL]). In addition, individuals with vitamin D deficiency had lower H pylori eradicate rate (OR = 0.09, 95% CI = [0.02, 0.41]). Sensitivity analysis showed that the meta-analysis results were stable and reliable.

CONCLUSIONS

Vitamin D was a protective factor to H pylori infection. Moreover, vitamin D can improve the success rate of H pylori eradication.

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

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 13 C-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 13 C-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.