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Kountouras J, Polyzos SA, Doulberis M, Zeglinas C, Artemaki F, Vardaka E, Deretzi G, Giartza-Taxidou E, Tzivras D, Vlachaki E, Kazakos E, Katsinelos P, Mantzoros CS. Potential impact of Helicobacter pylori-related metabolic syndrome on upper and lower gastrointestinal tract oncogenesis. Metabolism 2018; 87:18-24. [PMID: 29936174 DOI: 10.1016/j.metabol.2018.06.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/12/2022]
Abstract
Both Helicobacter pylori infection and metabolic syndrome present significant global public health burdens. Metabolic syndrome is closely related to insulin resistance, the major underlying mechanism responsible for metabolic abnormalities, and Helicobacter pylori infection has been proposed to be a contributing factor. There is growing evidence for a potential association between Helicobacter pylori infection and insulin resistance, metabolic syndrome and related morbidity, including abdominal obesity, type 2 diabetes mellitus, dyslipidemia, hypertension, all of which increase mortality related to cardio-cerebrovascular disease, neurodegenerative disorders, nonalcoholic fatty liver disease and malignancies. More specifically, insulin resistance, metabolic syndrome and hyperinsulinemia have been associated with upper and lower gastrointestinal tract oncogenesis. Apart from cardio-cerebrovascular, degenerative diseases and nonalcoholic fatty liver disease, a number of studies claim that Helicobacter pylori infection is implicated in metabolic syndrome-related Barrett's esophagus and esophageal adenocarcinoma development, gastric and duodenal ulcers and gastric oncogenesis as well as lower gastrointestinal tract oncogenesis. This review summarizes evidence on the potential impact of Helicobacter pylori-related metabolic syndrome on gastroesophageal reflux disease-Barrett's esophagus-esophageal adenocarcinoma, gastric atrophy-intestinal metaplasia-dysplasia-gastric cancer and colorectal adenoma-dysplasia-colorectal cancer sequences. Helicobacter pylori eradication might inhibit these oncogenic processes, and thus further studies are warranted.
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Affiliation(s)
- Jannis Kountouras
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Macedonia, Greece.
| | - Stergios A Polyzos
- First Department of Pharmacology, Department of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Macedonia, Greece
| | - Michael Doulberis
- Division of General Internal Medicine, University Hospital Inselspital of Bern, 3010 Bern, Switzerland
| | - Christos Zeglinas
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Macedonia, Greece
| | - Fotini Artemaki
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Macedonia, Greece
| | - Elizabeth Vardaka
- Department of Nutrition and Dietetics, Alexander Technological Educational Institute, Thessaloniki, Sindos, Macedonia, Greece
| | - Georgia Deretzi
- Department of Neurology, Papageorgiou General Hospital, Thessaloniki, Macedonia, Greece
| | | | | | - Efthymia Vlachaki
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Macedonia, Greece
| | - Evangelos Kazakos
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Macedonia, Greece
| | - Panagiotis Katsinelos
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Macedonia, Greece
| | - Christos S Mantzoros
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Kountouras J, Kapetanakis N, Polyzos SA, Katsinelos P, Gavalas E, Tzivras D, Zeglinas C, Kountouras C, Vardaka E, Stefanidis E, Kazakos E. Active Helicobacter pylori Infection Is a Risk Factor for Colorectal Mucosa: Early and Advanced Colonic Neoplasm Sequence. Gut Liver 2017; 11:733-734. [PMID: 28683520 PMCID: PMC5593337 DOI: 10.5009/gnl16389] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 02/13/2017] [Accepted: 03/03/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Jannis Kountouras
- Department of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Kapetanakis
- Department of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stergios A Polyzos
- Department of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Katsinelos
- Department of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanuel Gavalas
- Department of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitri Tzivras
- Department of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Zeglinas
- Department of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Constantinos Kountouras
- Department of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elizabeth Vardaka
- Department of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eyripidis Stefanidis
- Department of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evagelos Kazakos
- Department of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Athyros VG, Alexandrides TK, Bilianou H, Cholongitas E, Doumas M, Ganotakis ES, Goudevenos J, Elisaf MS, Germanidis G, Giouleme O, Karagiannis A, Karvounis C, Katsiki N, Kotsis V, Kountouras J, Liberopoulos E, Pitsavos C, Polyzos S, Rallidis LS, Richter D, Tsapas AG, Tselepis AD, Tsioufis K, Tziomalos K, Tzotzas T, Vasiliadis TG, Vlachopoulos C, Mikhailidis DP, Mantzoros C. The use of statins alone, or in combination with pioglitazone and other drugs, for the treatment of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis and related cardiovascular risk. An Expert Panel Statement. Metabolism 2017; 71:17-32. [PMID: 28521870 DOI: 10.1016/j.metabol.2017.02.014] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/23/2017] [Accepted: 02/25/2017] [Indexed: 02/07/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD), the most common liver disease, is characterized by accumulation of fat (>5% of the liver tissue), in the absence of alcohol abuse or other chronic liver diseases. It is closely related to the epidemic of obesity, metabolic syndrome or type 2 diabetes mellitus (T2DM). NAFLD can cause liver inflammation and progress to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis or hepatocellular cancer (HCC). Nevertheless, cardiovascular disease (CVD) is the most common cause of death in NAFLD/NASH patients. Current guidelines suggest the use of pioglitazone both in patients with T2DM and in those without. The use of statins, though considered safe by the guidelines, have very limited use; only 10% in high CVD risk patients are on statins by tertiary centers in the US. There are data from several animal studies, 5 post hoc analyses of prospective long-term survival studies, and 5 rather small biopsy proven NASH studies, one at baseline and on at the end of the study. All these studies provide data for biochemical and histological improvement of NAFLD/NASH with statins and in the clinical studies large reductions in CVD events in comparison with those also on statins and normal liver. Ezetimibe was also reported to improve NAFLD. Drugs currently in clinical trials seem to have potential for slowing down the evolution of NAFLD and for reducing liver- and CVD-related morbidity and mortality, but it will take time before they are ready to be used in everyday clinical practice. The suggestion of this Expert Panel is that, pending forthcoming randomized clinical trials, physicians should consider using a PPARgamma agonist, such as pioglitazone, or, statin use in those with NAFLD/NASH at high CVD or HCC risk, alone and/or preferably in combination with each other or with ezetimibe, for the primary or secondary prevention of CVD, and the avoidance of cirrhosis, liver transplantation or HCC, bearing in mind that CVD is the main cause of death in NAFLD/NASH patients.
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Affiliation(s)
- Vasilios G Athyros
- 2nd Prop. Department of Internal Medicine, Hippocration Hospital, Medical School of Aristotle University Thessaloniki, Greece.
| | - Theodore K Alexandrides
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Helen Bilianou
- Lipid Clinic, Cardiology Department, Tzaneio Hospital, Piraeus, Greece
| | - Evangelos Cholongitas
- 4th Prop. Department of Internal Medicine, Hippocration Hospital, Division of Gastroenterology and Hepatology, Medical School of Aristotle University Thessaloniki, Greece
| | - Michael Doumas
- 2nd Prop. Department of Internal Medicine, Hippocration Hospital, Medical School of Aristotle University Thessaloniki, Greece
| | - Emmanuel S Ganotakis
- Department of Internal Medicine University Hospital of Crete, University of Crete Medical School, Heraklion, Greece
| | - John Goudevenos
- Department of Cardiology Medical School, University Hospital of Ioannina, Ioannina, Greece
| | - Moses S Elisaf
- Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Georgios Germanidis
- 1st Department of Internal Medicine, Gastroenterology and Hepatology Section, AHEPA Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Olga Giouleme
- 2nd Prop. Department of Internal Medicine, Hippocration Hospital, Medical School of Aristotle University Thessaloniki, Greece
| | - Asterios Karagiannis
- 2nd Prop. Department of Internal Medicine, Hippocration Hospital, Medical School of Aristotle University Thessaloniki, Greece
| | - Charalambos Karvounis
- First Cardiology Department, AHEPA Hospital, Medical School, Aristotle University Thessaloniki, Greece
| | - Niki Katsiki
- 2nd Prop. Department of Internal Medicine, Hippocration Hospital, Medical School of Aristotle University Thessaloniki, Greece
| | - Vasilios Kotsis
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University Thessaloniki, Greece
| | - Jannis Kountouras
- 2nd Prop. Department of Internal Medicine, Hippocration Hospital, Medical School of Aristotle University Thessaloniki, Greece
| | - Evangelos Liberopoulos
- Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Christos Pitsavos
- 1st Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stergios Polyzos
- 2nd Prop. Propedeutic Department of Internal Medicine, Hippocration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Loukianos S Rallidis
- 2nd Department of Cardiology, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Apostolos G Tsapas
- 2nd Department of Internal Medicine-Diabetology, Hippocration Hospital, Aristotle University Thessaloniki, Medical School, Thessaloniki, Greece
| | - Alexandros D Tselepis
- Atherothrombosis Research Centre/Department of Chemistry, University of Ioannina, Ioannina, Greece
| | - Konstantinos Tsioufis
- 1st Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tziomalos
- 1st Prop. Department of Internal Medicine, AHEPA Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | | | - Themistoklis G Vasiliadis
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University Thessaloniki, Greece
| | - Charalambos Vlachopoulos
- 1st Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
| | - Christos Mantzoros
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Xu Y, Wang Q, Liu Y, Cui R, Lu K, Zhao Y. Association between Helicobacter pylori infection and carotid atherosclerosis in patients with vascular dementia. J Neurol Sci 2016; 362:73-7. [PMID: 26944122 DOI: 10.1016/j.jns.2016.01.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/03/2016] [Accepted: 01/14/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Accumulating evidence indicates that various infections contribute to the pathogenesis of atherosclerosis. Helicobacter pylori (Hp) has been implicated as a risk factor of atherosclerosis for stroke and other cardiovascular disease, but limited data exist regarding vascular dementia (VD). This study aimed to investigate the relationship between Hp infection and carotid atherosclerosis in patients with VD. METHODS A total of 354 patients who were diagnosed with VD were enrolled. Patients were divided into Hp positive VD group (n=208) and Hp negative VD group (n=156) using the (13)C-urea breath test ((13)C-UBT). Serum YKL-40, a marker for inflammation, were analyzed by ELISA. Traditional atherosclerotic risk factors including age, gender, body mass index (BMI), total cholesterol (TC), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), triglycerides (TG), systolic blood pressure (SBP), diastolic blood pressure (DBP) and fasting blood glucose (FBG) were collected or detected. Carotid intima-media thickness (CIMT) was determined by color Doppler ultrasound. RESULTS CIMT values and serum YKL-40 significantly increased in Hp positive VD group in comparison with Hp negative VD group (p<0.05). In Hp positive VD group, serum YKL-40 was positively correlated with CIMT (r=0.412, p<0.05), and the association was independent of traditional atherosclerotic risk factors (β=0.381, p<0.001). CONCLUSIONS CIMT and serum YKL-4 were significantly higher in Hp positive patients than Hp negative patients. Hp-induced inflammation may be a risk factor for atherosclerosis in patients with VD.
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Affiliation(s)
- Yuzhen Xu
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qian Wang
- Department of Central Laboratory, The Central Hospital of Tai'an, Taishan Medical College, Tai'an, Shandong Province, China
| | - Yunlin Liu
- Department of Neurology, The Central Hospital of Tai'an, Taishan Medical College, Tai'an, Shandong Province, China
| | - Ruiting Cui
- Department of Neurology, The Central Hospital of Tai'an, Taishan Medical College, Tai'an, Shandong Province, China
| | - Kaili Lu
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuwu Zhao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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Polyzos SA, Kountouras J. Novel Advances in the Association Between Helicobacter pylori Infection, Metabolic Syndrome, and Related Morbidity. Helicobacter 2015; 20:405-9. [PMID: 25854149 DOI: 10.1111/hel.12228] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Stergios A Polyzos
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece
| | - Jannis Kountouras
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece
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Franceschi F, Gasbarrini A, Polyzos SA, Kountouras J. Extragastric Diseases and Helicobacter pylori. Helicobacter 2015; 20 Suppl 1:40-6. [PMID: 26372824 DOI: 10.1111/hel.12256] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The extragastric manifestations of Helicobacter pylori infection still remain a very strong topic throughout the H. pylori world. Indeed, H. pylori may interfere with many biological processes, both inside and outside of the stomach, possibly influencing or determining the occurrence of many diseases outside of the stomach. While its role in idiopathic thrombocytopenic purpura and sideropenic anemia has already been recognized, emerging evidence suggests that H. pylori may increase the risk of acute coronary syndrome, contribute to insulin resistance and be associated with neurodegenerative, respiratory, and other miscellaneous disorders previously associated with other conditions. Different pathogenic mechanisms have been hypothesized, including the induction of a low-grade inflammatory state and the occurrence of molecular mimicry mechanisms. This review summarizes the results of the most relevant studies published on this topic in the last year.
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Affiliation(s)
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology, Catholic University of Rome, Rome, Italy
| | - Stergios A Polyzos
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Macedonia, Greece
| | - Jannis Kountouras
- Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Macedonia, Greece
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