Serum and Mucosal Cytokine Profiles in Patients with Active Helicobacter Pylori and Ischemic Heart Disease: Is There a Relationship?

An Updated Meta-Analysis of the Relationship Between Helicobacter pylori Infection and the Risk of Coronary Heart Disease

Background

Coronary heart disease (CHD) is one of the leading causes of mortality in the world. Although the traditional risk factors for CHD have been identified, it seems that there are still many CHD cases without these factors. Previous studies have hypothesized that Helicobacter pylori (H. pylori) infection was associated with the risk of CHD.

Objective

The association between H. pylori infection and the risk of CHD was studied using a systematic evaluation and meta-analysis method.

Methods

In order to find relevant studies, four electronic databases were systematically searched until August 2021. According to the inclusion and exclusion criteria, studies were screened and data were extracted. Under the random-effects or the fixed-effects model, the odds ratio (OR) and 95% confidence interval (95% CI) were combined. All analyses were conducted using Review Manager software (RevMan 5.4).

Results

Among the included studies, 2 studies were analyzed for H. pylori stool antigen test, 2 studies were analyzed for H. pylori histological staining test, 13 studies were analyzed for the anti-CagA test, and 38 studies were analyzed for the anti-H. pylori IgG test. The pooled results revealed that positive anti-H. pylori IgG was significantly associated with an increased risk of CHD (OR, 1.58; 95% CI: 1.34–1.87). Similarly, positive anti-CagA, positive H. pylori stool antigen, and positive H. pylori histological staining were significantly associated with the development of CHD with (OR: 1.33, 95% CI: 1.16–1.53), (OR: 3.50, 95% CI: 1.60–7.66), and (OR: 1.78, 95% CI: 1.12–2.83), respectively.

Conclusion

This meta-analysis showed that H. pylori infection increased the risk of CHD. However, more studies are needed to further investigate whether early eradication of H. pylori may reduce the morbidity of CHD.

Use of Fourier-Transform Infrared Spectroscopy (FT-IR) for Monitoring Experimental Helicobacter pylori Infection and Related Inflammatory Response in Guinea Pig Model

Infections due to Gram-negative bacteria Helicobacter pylori may result in humans having gastritis, gastric or duodenal ulcer, and even gastric cancer. Investigation of quantitative changes of soluble biomarkers, correlating with H. pylori infection, is a promising tool for monitoring the course of infection and inflammatory response. The aim of this study was to determine, using an experimental model of H. pylori infection in guinea pigs, the specific characteristics of infrared spectra (IR) of sera from H. pylori infected (40) vs. uninfected (20) guinea pigs. The H. pylori status was confirmed by histological, molecular, and serological examination. The IR spectra were measured using a Fourier-transform (FT)-IR spectrometer Spectrum 400 (PerkinElmer) within the range of wavenumbers 3000–750 cm⁻¹ and converted to first derivative spectra. Ten wavenumbers correlated with H. pylori infection, based on the chi-square test, were selected for a K-nearest neighbors (k-NN) algorithm. The wavenumbers correlating with infection were identified in the W2 and W3 windows associated mainly with proteins and in the W4 window related to nucleic acids and hydrocarbons. The k-NN for detection of H. pylori infection has been developed based on chemometric data. Using this model, animals were classified as infected with H. pylori with 100% specificity and 97% sensitivity. To summarize, the IR spectroscopy and k-NN algorithm are useful for monitoring experimental H. pylori infection and related inflammatory response in guinea pig model and may be considered for application in humans.

A meta-analysis of the association between Helicobacter pylori infection and risk of atherosclerotic cardiovascular disease

BACKGROUND

Helicobacter pylori (H pylori) infection may be a risk factor for cardiovascular disease (CVD), but the reported researches have given conflicting results.

AIMS

To investigate the association between H pylori infection and risk of atherosclerotic CVD.

MATERIALS AND METHODS

The studies were retrieved in Embase, PubMed, Web of Science (published from Jan 1, 1990, to Jan 31, 2020, language restrictions: English). All studies included used data from case-control studies and cohort studies of cardiovascular adverse events. Random effect models were used to measure pooled estimates. All data were analyzed with Stata 11.2 SE (StataCorp, College Station, TX).

RESULTS

Helicobacter pylori infection increased the risk of adverse cardiovascular events by 51% (40 studies, n = 19 691, odd ratio [OR] = 1.51, 95% confidence interval [CI]: 1.34-1.70). The effect was greater for studies that the type of CVDs was myocardial infarction (MI) and cerebrovascular disease (MI OR = 1.80, 95% CI: 1.42-2.26, cerebrovascular disease OR = 1.54, 95% CI: 1.27-1.89). Meanwhile, CagA seropositive H pylori strains were associated with a significantly increased risk of cardiovascular adverse events based on published research data (OR = 1.73, 95% CI: 1.40-2.14).

CONCLUSION

In conclusion, H pylori infection enhanced the risk of atherosclerotic cardiovascular adverse events, especially in some patients with MI and cerebrovascular disease. This study will provide guidance for the targeted prevention and treatment of CVDs. But this association need to be confirmed by more prospective studies.

Influence of Helicobacter pylori Infection on Metabolic Syndrome in Old Chinese People

Background. H. pylori infection is one of the most common chronic infectious inflammatory diseases worldwide and is also a risk factor for atherosclerosis. Patients with metabolic syndrome are known to be at increased risk for atherosclerosis. The aim of our study was to assess the effects of H. pylori infection on serum lipids, body mass index (BMI), and metabolic syndrome in old Chinese people. Material and Method. A total of 191 (133 males and 58 females, aged 73.19 ± 11.03 years) people who had gastroscopy examination in our hospital were divided into H. pylori-positive group (n = 80) and H. pylori-negative group (n = 111). H. pylori infection was diagnosed by rapid urease test. Results. Patients with H. pylori infection had higher BMI and fasting glucose levels and incidence of metabolic syndrome (p < 0.01). It was found that BMI (p < 0.01, OR 74.469), H. pylori infection (p < 0.01, OR 5.427), total cholesterol (p < 0.01, OR 15.544), and diabetes mellitus (p < 0.01, OR 23.957) were significantly associated with the risk of metabolic syndrome by binary logistic regression analysis. Conclusions. Patients with H. pylori infection had higher BMI and fasting glucose levels and had incidence of metabolic syndrome.

Helicobacter Pylori Infection is Positively Associated with Metabolic Syndrome in Taiwanese Adults: a Cross-Sectional Study

BACKGROUND

Helicobacter pylori infection and metabolic syndrome have been reported to be positively associated. However, only a few studies have focused on this issue, and H. pylori serum antigen was used to diagnose infection in most of them. We aimed to investigate the association between metabolic syndrome factors and H. pylori infection, as diagnosed via a (13)C-urea breath test.

MATERIALS AND METHODS

This cross-sectional study consisted of 3578 subjects (18-64 years old) enrolled from one health management center between 2008 and 2013. H. pylori infection was defined as a positive urea breath test. The risk of metabolic syndrome from H. pylori infection was assessed using a multiple logistic regression model.

RESULTS

The prevalence of the H. pylori was similar in both genders (20.6% in men and 19.7% in women). H. pylori -infected participants had significantly higher body mass index, fasting glucose, low-density lipoprotein, and triglycerides, and lower high-density lipoprotein (p < 0.05), than uninfected ones (p < 0.05). The prevalence of metabolic syndrome was higher in H. pylori -infected subjects than uninfected ones (men: 12.4% vs. 7.4%, p < 0.001; women: 7.4% vs. 2.5%, p < 0.001). Furthermore, H. pylori infection prevalence increased with metabolic score (P for trend <0.001, both sexes). Moreover, the association between metabolic syndrome and UBT positivity was significant in females (OR 1.91, 95% CI:1.03-3.53), but only borderline significant in males (OR 1.38, 95% CI: 0.97-1.95).

CONCLUSION

H. pylori infection is positively associated with metabolic syndrome, especially in females. The causal relationship between H. pylori infection and metabolic syndrome warrants further investigation.

Helicobacter pylori infection associated with high HbA1c and type 2 diabetes

BACKGROUND

Although the association between chronic Helicobacter pylori infection and type 2 diabetes has been suggested, findings have been inconsistent. This study evaluated the association between chronic H. pylori infection and glucose regulation.

MATERIALS AND METHODS

We evaluated H. pylori infection status of participants recruited from the gastroenterology clinic at our hospital. At baseline, we performed blood tests including fasting plasma glucose, insulin, glycated haemoglobin A1c (HbA1c) and other biochemical measurements. Insulin resistance and beta-cell function were assessed by homoeostasis model assessment (HOMA-IR and HOMA-B, respectively).

RESULTS

A total of 2070 participants were recruited. Those who had H. pylori infections had higher serum HbA1c levels and lower HOMA-B than those who did not (5.78% vs. 5.69%, P = 0.01 and 53.85 + 38.43 vs. 60.64 + 43.40, P = 0.009, respectively). They also had a significantly higher prevalence of type 2 diabetes (8.97% vs. 5.57%, P= 0.02). Chronic H. pylori infection was significantly associated with high levels of HbA1c and type 2 diabetes in participants above 65 years old (P = 0.001) and decreased insulin secretion and sensitivity in those under 45 years (P = 0.05).

CONCLUSIONS

Long-term H. pylori infection is significantly associated with high levels of HbA1c and decreased insulin secretion in this Chinese population. Proper screening for H. pylori infection combined with regular monitoring of blood glucose and HbA1c levels might be effective for the early detection of glucose dysregulation and prevention of type 2 diabetes.

Helicobacter pylori infection significantly increases insulin resistance in the asymptomatic Japanese population

BACKGROUND

Helicobacter pylori infection has been shown to contribute to atherosclerosis and cardiovascular diseases. Insulin resistance is the pathophysiologic background of the clinical features of atherosclerosis and cardiovascular diseases. We examined the association between H. pylori infection and insulin resistance in a large Japanese population.

MATERIALS AND METHODS

Fifteen hundred ninety-eight consecutive asymptomatic subjects that underwent a complete medical survey in our institute between May 2007 and July 2008 were recruited. Cases under medication for hypertension, hyperlipidemia, diabetes mellitus, hyperuricemia, or cardiovascular diseases were excluded from the study. Cases suffering from chronic renal or liver failure were also excluded. The homeostasis model assessment of insulin resistance (HOMA-IR) score was used to quantitatively estimate insulin resistance. Visceral and subcutaneous adipose tissues (SAT) were measured by computed tomography. The association between H. pylori serostatus and HOMA-IR score was investigated by multivariate regression analysis.

RESULTS

A total of 988 men and 119 women were eventually eligible for this cross-sectional survey. Helicobacter pylori seropositivity was significantly higher in 99 cases with insulin resistance (HOMA-IR >or=2.5) compared with 1008 cases without insulin resistance (HOMA-IR <2.5) (39.4 vs 28.7%, p = .027). There was a significant association between H. pylori serostatus and HOMA-IR score by multiple linear regression analysis (coefficients = 0.152, 95% CI = 0.058-0.246, p = .001), after adjusting for sex, age, body mass index, waist girth, visceral and subcutaneous adipose tissues, smoking status, alcohol consumption, dietary habits, and physical activity.

CONCLUSIONS

Helicobacter pylori infection significantly and independently contributed to promoting insulin resistance in a large asymptomatic population.

Associations of plasma IL-8 levels withHelicobacter pyloriseropositivity, gastric atrophy, andIL-8T-251A genotypes

There are few data on circulatory pro-inflammatory cytokine levels and cytokine gene polymorphisms inH. pylori-positive patients. A cross-sectional study was conducted to examine the effects ofH. pyloriinfection, gastric atrophy, and theIL-8T-251A polymorphism on plasma IL-8 levels in 98 Japanese adults. Seventy-one subjects were positive forH. pyloriinfection. The geometric mean of plasma IL-8 concentration was significantly higher in subjects withH. pyloriinfection than in those without (P=0·001). The development of atrophy was negatively associated with IL-8 levels in theH. pylori-positive subjects, although not significantly. Plasma IL-8 levels in the T/T genotype were associated withH. pyloriinfection and atrophy status (P=0·016). Our findings suggested that circulating IL-8 levels were associated withH. pyloriinfection. The effect ofH. pyloriinfection on plasma IL-8 levels was not clearly modified by theIL-8T-251A polymorphism.

Impact of Porcine Orexin a on Glucagon Plasma Concentrations in Pigs

In 1998, Orexin A was added to the long list of orexigenic neuropeptides of the brain's physiology. Orexin A is involved in the central control of appetite and in energy homeostasis, as well as in the regulation of many other physiological functions. It is produced by a small cluster of the brain's neurons, located mainly in and around the lateral hypothalamic area. This site is known to be involved in regulating feeding in mammals. An intracerebroventricular injection of Orexin A into the rat's brain causes an impressive increase in the consumption of food, while an intravenous injection induces changes on glucagon plasma concentrations in rats. In addition, there are signs of changes on glucagon plasma concentrations when Orexin A acts on individual pancreatic islets of rats. In this study, we investigated the potential effects of the central administration of porcine Orexin A on glucagon plasma concentrations in pigs, and examined whether these changes are associated with the possible effect of the neuropeptide on the enteroinsular axis.

An alternative salvage regimen for Helicobacter pylori-resistant patients with heart failure

Helicobacter pylori infects over 50% of the worldwide population. For eradication, European, Canadian, and American guidelines recommend a regimen consisting of a proton pump inhibitor, clarithromycin, and metronidazole or amoxicillin dosed twice daily for at least 7 days. When this treatment strategy fails, a complex, multidosed bismuth-based quadruple regimen is recommended. Unfortunately, for patients with heart failure, this salvage regimen can be potentially hazardous due to the drug-drug interaction with tetracycline and digoxin, as well as the large salicylate content with bismuth subsalicylate. As H. pylori infection is so prevalent, providers will most likely encounter such a therapeutic dilemma. A safe, effective, and simplistic alternative is a 10-day fluoroquinolone-based regimen consisting of a proton pump inhibitor, levofloxacin and either clarithromycin or amoxicillin. Levofloxacin demonstrates excellent bioavailability, widespread tissue and fluid distribution, extended half-life, limited drug interaction profile, low incidence of side effects, and remarkable activity against H. pylori with minimal primary resistance. Compared to the 7-day quadruple regimen, a 10-day levofloxacin-based regimen demonstrated a greater eradication rate, better tolerability, and a lower rate of therapy discontinuation. We briefly provide a summary of the data regarding this levofloxacin-based regimen and two successful cases from our heart failure clinic.

Extragastric manifestations of Helicobacter pylori infection -- other Helicobacters

Today there is evidence that Helicobacter pylori has a critical role in different extragastric diseases. The discovery of a number of other novel Helicobacter species has stimulated the research in different extragastric diseases, in which an infectious hypothesis is plausible. Enterohepatic Helicobacter species have been hypothesized to play a role in different disorders, including hepatocellular carcinoma, gallstones formation and cholangiocellular carcinoma, as well as enteric diseases and inflammatory bowel diseases. Concerning the extragastric manifestations of H. pylori infection, idiopathic thrombocytopenic purpura, and sideropenic anemia represent, based on the current data, the diseases in which the pathogenic link appears to be strongest. There is also an increasing evidence for a possible association of H. pylori with cardiovascular disease.