Metabolic consequences of Helicobacter pylori infection and eradication

Abstract

Helicobacter pylori (H. pylori) is still the most prevalent infection of the world. Colonization of the stomach by this agent will invariably induce chronic gastritis which is a low-grade inflammatory state leading to local complications (peptic ulcer, gastric cancer, lymphoma) and remote manifestations. While H. pylori does not enter circulation, these extragastric manifestations are probably mediated by the cytokines and acute phase proteins produced by the inflammed mucosa. The epidemiologic link between the H. pylori infection and metabolic changes is inconstant and controversial. Growth delay was described mainly in low-income regions with high prevalence of the infection, where probably other nutritional and social factors contribute to it. The timely eradication of the infection will lead to a more healthy development of the young population, along with preventing peptic ulcers and gastric cancer An increase of total, low density lipoprotein and high density liporotein cholesterol levels in some infected people creates an atherogenic lipid profile which could promote atherosclerosis with its complications, myocardial infarction, stroke and peripheral vascular disease. Well designed and adequately powered long-term studies are required to see whether eradication of the infection will prevent these conditions. In case of glucose metabolism, the most consistent association was found between H. pylori and insulin resistance: again, proof that eradication prevents this common metabolic disturbance is expected. The results of eradication with standard regimens in diabetics are significantly worse than in non-diabetic patients, thus, more active regimens must be found to obtain better results. Successful eradication itself led to an increase of body mass index and cholesterol levels in some populations, while in others no such changes were encountered. Uncertainities of the metabolic consequences of H. pylori infection must be clarified in the future.

Keywords: Diabetes mellitus, Cytokines, Glucose homeostasis, Growth, Helicobacter pylori, Interleukins, Lipid metabolism, Metabolic syndrome

Core tip: Although Helicobacter pylori (H. pylori) in considered the main cause of peptic ulcer, gastric cancer and mucosa-associated lymphoid tissue lymphoma, the infection could induce many extragastric manifestations: among them, the metabolic disturbances are less well debated. Growth-as expression of general metabolism-could be delayed especially in low income-high infection prevalence regions and this can be restored by timely eradication of the infection. H. pylori infection may be associated with increased total and low density lipoprotein cholesterol and decrease of high density liporotein, creating an atherogenic lipid profile and promoting atherosclerosis. H. pylori is consistently associated with insulin resistance. In the future, larg-scale studies are needed to clarify if eradication of H. pylori will result in restoration of normal growth, decrease of atherosclerotic disease, type 2 diabetes mellitus and metabolic syndrome.