Associations of Helicobacter pylori infection and peptic disease with diabetic mellitus: Results from a large population-based study

The impact of prebiotic fructooligosaccharides on gut dysbiosis and inflammation in obesity and diabetes related kidney disease

Obesity is an extensive health problem worldwide that is frequently associated with diabetes. It is a risk factor for the development of several diseases including diabetic nephropathy. Recent studies have reported that gut dysbiosis aggravates the progression of obesity and diabetes by increasing the production of uremic toxins in conjunction with gut barrier dysfunction which then leads to increased passage of lipopolysaccharides (LPS) into the blood circulatory system eventually causing systemic inflammation. Therefore, the modification of gut microbiota using a prebiotic supplement may assist in the restoration of gut barrier function and reduce any disturbance of the inflammatory response. In this review information has been compiled concerning the possible mechanisms involved in an increase in obesity, diabetes and kidney dysfunction via the exacerbation of the inflammatory response and its association with gut dysbiosis. In addition, the role of fructooligosaccharides (FOS), a source of prebiotic widely available commercially, on the improvement of gut dysbiosis and attenuation of inflammation on obese and diabetic conditions has been reviewed. The evidence confirms that FOS supplementation could improve the pathological changes associated with obesity and diabetes related kidney disease, however, knowledge concerning the mechanisms involved is still limited and needs further elucidation.

Factors associated with gastro-duodenal ulcer in compensated type 2 diabetic patients: a Romanian single-center study

INTRODUCTION

Helicobacter pylori infection is accepted as the leading cause of chronic gastritis, ulcer disease and gastric cancer, with an important impact on health care burden, especially in countries with a high prevalence of infection. The aim of the study was to investigate the influence of H. pylori infection, medication, associated medical conditions or social habits on endoscopic ulcer occurrence in the compensated type 2 diabetic population.

MATERIAL AND METHODS

Two hundred and sixty type 2 diabetic patients investigated on endoscopy (57 patients with peptic ulcer and 203 controls) with a complete set of biopsies, demographic and medical data were enrolled.

RESULTS

On univariate regression analysis, H. pylori infection (42.1% vs. 35.5%, p = 0.359) or a history of peptic ulcer (61.4% vs. 61.6%, p = 0.981) was not a predictor for ulcer on endoscopy in the diabetic population, and heartburn was more frequent in diabetics without ulcer (21.2% vs. 8.8%, p = 0.033). Anemia was the best predictor for ulcer on endoscopy in both diabetics with (p < 0.001, OR = 4.77, 95% CI: 2.02-11.28) and without (p = 0.027, OR = 2.76, 95% CI: 1.10-6.91) chronic proton pump inhibitor (PPI) therapy. In diabetic patients on PPI more than 1 month anticoagulants - acenocoumarol or low-weight molecular heparin (p = 0.038, OR = 2.37, 95% CI: 1.04-5.40), low-dose aspirin 75-125 mg/day (p = 0.029, OR = 2.61, 95% CI: 1.08-6.28) and alcohol consumption (p = 0.015, OR = 2.70, 95% CI: 1.19-6.13) were predictors for ulcer on endoscopy.

CONCLUSIONS

In diabetic patients, anemia is the most important predictor for ulcer on endoscopy, but not H. pylori or digestive symptoms, while low-dose aspirin or anticoagulant therapy and alcohol consumption are the most important predictors for ulcer in diabetics on chronic proton pump inhibitor therapy.

Helicobacter pylori and the intestinal microbiome among healthy school-age children

BACKGROUND

Helicobacter pylori (H. pylori) infection is acquired during childhood and causes chronic gastritis that remains asymptomatic in most infected people. H. pylori alters the gastric microbiota and causes peptic ulcer disease. Evidence on the relationship between asymptomatic H. pylori infection and children's gut microbiota remains elusive.

AIM

We characterized the relationship between H. pylori infection and the intestinal microbiome of healthy children, adjusting for known inter-personal and environmental exposures.

MATERIALS AND METHODS

This cross-sectional study included stool samples obtained from 163 Israeli Arab children aged 6-9 years from different socioeconomic strata. Sociodemographic information was collected through maternal interviews. H. pylori infection was determined using monoclonal antigen detection stool enzyme immunoassay. The gut microbiome was characterized by implementing 16S rRNA gene sequencing of the V4 region and a multivariate downstream analysis.

RESULTS

Overall, 57% of the participants were positive for H. pylori infection and it was significantly associated with low socioeconomic status. There was no significant association between H. pylori infection and bacterial richness of fecal microbiome. H. pylori infection was significantly associated with intestinal bacterial composition, including a strong association with Prevotella copri and Eubacterium biforme. Moreover, socioeconomic status was strongly associated with bacterial composition.

DISCUSSION AND CONCLUSIONS

H. pylori infection in healthy children was significantly associated with altered intestinal microbiome structure. Socioeconomic determinants exhibit a strong effect, related to both H. pylori infection and intestinal diversity and composition in childhood. These findings are clinically important to the understanding of the role of H. pylori infection and other intestinal microbes in health and disease.

Differences in glycated hemoglobin levels and cholesterol levels in individuals with diabetes according to Helicobacter pylori infection

This study examined differences in glycated hemoglobin (HbA1c), fasting plasma glucose and cholesterol levels between H. pylori infected and uninfected persons with diabetes. Anonymized data of Maccabi Healthcare Services in Israel were analyzed, of 12,207 individuals (50.0% H. pylori positive) aged 25–95 years who underwent the urea breath test. The data included HbA1c, fasting plasma glucose and cholesterol levels. The inverse probability of treatment weighting approach was used to account for confounders. Differences between individuals who were H. pylori positive and negative, in HbA1c (> or ≤ 7.0%) and in cholesterol levels were assessed using weighted generalized estimating equations. For men, but not women, the likelihood of having HbA1c > 7.0% was increased in those infected than uninfected with H. pylori: prevalence ratio 1.11 (95% CI 1.00, 1.24), P = 0.04. For both sexes, total cholesterol (P = 0.004) and low-density lipoprotein (LDL) levels (P = 0.006) were higher among those infected than uninfected with H. pylori. No significant differences were found in glucose and HDL levels according to H. pylori infection. The results were consistent in unweighted multivariable analyses. In conclusion, H. pylori infection might be related to worse glycemic control in men, and higher total cholesterol and LDL cholesterol levels in both sexes.

Helicobacter pylori and diabetes mellitus: a controversial relationship

Research on Helicobacter pylori (H. pylori), a pathogenic bacterium that is widespread among humans, is investigating the medical implications of the infection in many fields beyond gastroenterology. Because of the ubiquitous presence of the infection, there is an increasing interest in finding a relationship between this bacterium and diabetes mellitus (DM). It is not clear whether a significant relation between H. pylori and DM exists, whether the infection influences diabetes or vice versa, and the mechanisms underlying such a relationship. This review provides an analysis of new insights from studies published in more recent years. New research on this topic concentrated on the common pathogenic aspects between the bacterium and insulin resistance or autoimmunity, on the role of the bacterial infection in cardiovascular risk and whether the infection worsen glycemic outcomes in patients with DM. Research in this field still has to conclusively assess and explain the existence of a possible relationship between H. pylori and DM. Some studies have reached antithetic conclusions. Unless more robust data from studies using consistent research methods become available in the near future, people with diabetes should be compared to the general population when it comes to investigating and treating the presence of H. pylori.

Association between Helicobacter pylori infection and nonalcoholic fatty liver disease: a systemic review and meta-analysis

Although clinical studies have shown possible links of Helicobacter pylori infection with the development of nonalcoholic fatty liver disease (NAFLD), the results remain controversial. The aim of this meta-analysis is to investigate the association between H. pylori infection and NAFLD. A comprehensive search of relevant studies was performed up to November 2018. Data on H. pylori infection in NAFLD patients and controls were extracted. Odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. Twelve studies involving 27 400 NAFLD patients and 60 347 controls were included. The pooled overall OR of H. pylori infection in NAFLD patients compared with controls was 1.36 (95% CI: 1.22-1.53, I=89.6%, P=0.000). Meta-regression and subgroup analysis showed that the sample size and the case-control ratio may have accounted for some of the heterogeneity. When stratified by publication year, the diagnostic method used for H. pylori, and Newcastle-Ottawa Scale scores, the OR remained significant. However, possible publication bias was observed. Of the 12 studies, six had carried out multivariable analysis after adjusting for potential confounders. The pooled results from these studies still indicated a higher risk of NAFLD in patients infected with H. pylori (OR=1.17, 95% CI: 1.01-1.36, I=72.4%, P=0.003). There is a 36% increased risk of NAFLD in patients with H. pylori infection. Further studies are warranted to investigate whether eradication of H. pylori is useful in the prevention and treatment of NAFLD.

Helicobacter pylori infection and prevalence of stroke

BACKGROUND

Helicobacter pylori causes peptic ulcer disease; however, conflicting evidence exists regarding its role in extragastric conditions. We aimed to examine associations of H pylori infection and peptic ulcer disease with stroke.

METHODS

A cross-sectional study was undertaken using data of 147 936 individuals aged 25-95 years who underwent the urea breath test during 2002-2012, based on the computerized database of the second largest health maintenance organization in Israel. Logistic regression models were fitted to control for potential confounders.

RESULTS

Overall, 1397 (0.9%) patients had stroke and 76 965 (52.0%) had a H pylori positive test. The likelihood of prevalent stroke increased in relation to H pylori infection: adjusted odds ratio (aOR) 1.16 (95% confidence intervals [CI]: 1.04-1.29), gastric ulcer: aOR 1.50 (95% CI: 1.18-1.91), and duodenal ulcer: aOR 1.25 (95% CI: 1.07-1.46).

CONCLUSIONS

The results support the premise that stroke may be associated with a history of H pylori infection.

Helicobacter pylori infection, gestational diabetes mellitus and insulin resistance among pregnant Sudanese women

Objectives

To assess the association between Helicobacter pylori (H. pylori) infection and insulin resistance among pregnant Sudanese women attending Saad Abuelela hospital (Khartoum). A cross-sectional study was conducted from 1st July 2017 to 31st January 2018. One hundred and sixty-six women were enrolled and underwent testing for H. pylori IgG antibodies using specific ELISA kits. The Quantitative insulin sensitivity check index (QUICKI) was computed from the fasting insulin and glucose levels.

Results

Median age, gravidity and gestational age were 27 years, 2 and 26 weeks, respectively. Twenty (12%) women were found to have gestational diabetes mellitus (GDM). H. pylori IgG seroprevalence was 66.0% among the study population. Univariate analysis showed that H. pylori-seropositivity was significantly higher among women who have GDM while Log (Homeostatic Model Assessment-β) HOMA-B% was lower (P value = 0.038, and 0.028) respectively. There was no difference between the GDM group and the other group in terms of demographics, body mass index, haemoglobin and QUICKI index results. In multivariate analysis, a higher prevalence of H. pylori was associated with GDM (OR = 2.8, 95% CI  1.1–7.5, P = 0.036). The current study concludes that an increased prevalence of H. pylori is a risk factor for the development of GDM.

Relationships of H. pylori infection and its related gastroduodenal morbidity with metabolic syndrome: a large cross-sectional study

The few published studies on the relationship between Helicobacter pylori infection and metabolic homeostasis were relatively small and yielded inconsistent results. We examined the prevalence of metabolic syndrome in relation to H. pylori infection and its symptoms in a large and unselected population. Coded data from the computerised database of a large health maintenance organisation in Israel were accessed for 147,936 individuals 25–95 years of age who performed the urea breath test during 2002–2012. The classification of metabolic syndrome followed a modified definition of the international diabetes federation. Prevalences of H. pylori infection and metabolic syndrome were 52.0% and 11.4% respectively. H. pylori infected patients had increased likelihood of metabolic syndrome: adjusted odds ratio (aOR) 1.15 (95% confidence intervals (CI) 1.10–1.19), as did patients with gastric ulcer: aOR 1.15 (95% CI 1.03–1.28) vs patients without these conditions. Duodenal ulcer was associated with metabolic syndrome only in persons aged 25–34 years: aOR 1.59 (95% CI 1.19-2.13), but not in older persons (P = 0.001 for heterogeneity). In conclusion, the likelihood of metabolic syndrome appeared significantly increased in relation to H. pylori infection and gastric and duodenal ulcers. These findings suggest that H. pylori long-term gastric inflammation might play a role in metabolic homeostasis.

Clinical effects of evidence-based nursing care in elderly patients with type 2 diabetes and peptic ulcer

AIM

To evaluate the clinical effects of evidence-based nursing in elderly patients with type 2 diabetes and peptic ulcer and utilize evidence-based methods to improve their quality of life.

METHODS

One hundred and thirty elderly patients with type 2 diabetes with peptic ulcer treated from August 2014 to August 2016 were divided into either a control group (n = 65) or an observation group (n = 65). The control group was given traditional nursing, and the observation group was given evidence-based nursing care. The levels of blood sugar, therapeutic effect for peptic ulcer, quality of life, and nursing satisfaction were compared between the two groups.

RESULTS

The levels of fasting blood glucose, postprandial sugar, and glycosylated hemoglobin were significantly lower in the observation group than in the control group (6.15 mmol/L ± 0.92 mmol/L vs 6.92 mmol/L ± 1.07 mmol/L, 8.21 mmol/L ± 1.39 mmol/L vs 9.82 mmol/L ± 1.51 mmol/L, and 6.65% ± 1.01% vs 7.86% ± 1.16%, P < 0.05). The cure rate and improvement rate for peptic ulcer were significantly higher in the observation group than in the control group (58.46% vs 38.46%, P < 0.05). The length of hospitalization was significantly shorter in the observation group than in the control group (19.61 d ± 5.32 d vs 23.65 d ± 6.18 d, P < 0.05). The scores of daily activities, sleep quality, mental outlook, appetite, and disease cognition in the observation group were significantly higher than those in the control group (P < 0.05). The rate of satisfaction with nursing was significantly higher in the observation group than in the control group (93.85% vs 70.77%, P < 0.05).

CONCLUSION

Evidence-based nursing care has significant clinical effects in elderly patients with type 2 diabetes with peptic ulcer and is worthy of recommendation.