Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2018; 24(3): 397-407
Published online Jan 21, 2018. doi: 10.3748/wjg.v24.i3.397
Helicobacter pylori and corpus gastric pathology are associated with lower serum ghrelin
Paula Mantero, Gonzalo Sebastián Matus, Rodolfo Ernesto Corti, Ana María Cabanne, Gerardo Gabriel Zerbetto de Palma, Liliana Marchesi Olid, María Marta Piskorz, Marcela Beatriz Zubillaga, Mariana Andrea Janjetic, Cinthia Gabriela Goldman
Paula Mantero, Gerardo Gabriel Zerbetto de Palma, Marcela Beatriz Zubillaga, Mariana Andrea Janjetic, Cinthia Gabriela Goldman, Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Física, Buenos Aires C1113AAD, Argentina
Gonzalo Sebastián Matus, Rodolfo Ernesto Corti, Hospital de Gastroenterología “Dr. Carlos Bonorino Udaondo”, Sección Esófago-Estómago, Buenos Aires C1264AAA, Argentina
Ana María Cabanne, Hospital de Gastroenterología "Dr. Carlos Bonorino Udaondo”, Unidad Patología, Buenos Aires C1264AAA, Argentina
Gerardo Gabriel Zerbetto de Palma, Universidad de Buenos Aires - CONICET, Facultad de Medicina, Instituto de Microbiología y Parasitología Médica (IMPAM), Buenos Aires C1121ABG, Argentina
Liliana Marchesi Olid, Mariana Andrea Janjetic, Universidad de Buenos Aires, Facultad de Medicina, Escuela de Nutrición, Buenos Aires C1121ABG, Argentina
María Marta Piskorz, Hospital de Clínicas “José de San Martín”, División Gastroenterología, Buenos Aires C1120AAR, Argentina
Marcela Beatriz Zubillaga, Mariana Andrea Janjetic, Cinthia Gabriela Goldman, National Scientific and Technical Research Council (CONICET), Buenos Aires C1425FQB, Argentina
Author contributions: Janjetic MA and Goldman CG formulated the research questions and designed the study; Mantero P, Matus GS, Corti RE, Zerbetto de Palma GG, Marchesi Olid L and Piskorz MM collected samples and data; Mantero P, Cabanne AM, Zerbetto de Palma GG and Goldman CG performed experiments; Janjetic MA performed the statistical analysis; Mantero P, Zubillaga MB, Janjetic MA and Goldman CG interpreted data; Mantero P, Janjetic MA and Goldman CG wrote the article; all authors have read and approved the final manuscript.
Supported by the Universidad de Buenos Aires (UBA), Buenos Aires, Argentina, No. UBACYT 20020100100837 and No. UBACYT 20020130100645BA to Goldman CG; and the International Atomic Energy Agency (IAEA), Vienna, Austria, Coordinated Research Project (CRP) E43025 No. ARG-16746 to Goldman CG. UBA and IAEA had no role in the design, analysis or writing of the present article.
Institutional review board statement: The study was reviewed and approved by the Hospital de Gastroenterología “Dr. Carlos Bonorino Udaondo” and the Hospital de Clínicas “José de San Martín” Institutional Review Boards.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Cinthia Gabriela Goldman, PhD, Adjunct Professor, Research Scientist, Physics Department, School of Pharmacy and Biochemistry, University of Buenos Aires, Junín 956, Buenos Aires C1113AAD, Argentina. cgold@ffyb.uba.ar
Telephone: +54-11-52874551 Fax: +54-11-52874563
Received: November 4, 2017
Peer-review started: November 4, 2017
First decision: November 14, 2017
Revised: November 30, 2017
Accepted: December 4, 2017
Article in press: December 4, 2017
Published online: January 21, 2018
Research background

The stomach participates in the production of ghrelin and leptin, two important neuroendocrine hormones in food intake modulation. Helicobacter pylori (H. pylori) infection has been associated with several pathologies affecting the gastroduodenal mucosa, for which reason it would be important to find out whether it could alter circulating levels of these hormones and ultimately, the body mass index (BMI).

Research motivation

Although the influence of H. pylori infection on the hormonal regulation of food intake has been addressed lately, the results are controversial.

Research objectives

The present study aimed to evaluate the relationship between H. pylori infection, cagA genotype, type of gastric pathology, serum ghrelin and leptin concentrations and nutritional status in patients with gastrointestinal symptoms.

Research methods

This cross-sectional study included fasted dyspeptic adults (18-70 y) referred for an upper digestive endoscopy. We conducted a survey for sociodemographic variables evaluation and a 24 h dietary recall for food intake estimation. H. pylori status was determined by three methods: histological analysis, PCR amplification of the vacA constitutive H. pylori gene and 13C -Urea Breath Test. Total ghrelin and leptin serum concentrations were measured by enzyme-linked immunosorbent assay and enzyme amplified sensitivity immunoassay respectively. During an upper gastrointestinal endoscopy, four gastric biopsies were obtained. One sample of each gastric site was used for histological assessment and the others for PCR amplification of H. pylori vacA and cagA genes. Statistical analysis was performed using χ2, Mann-Whitney U, Kruskal-Wallis tests, Spearman’s correlation and linear regression.

Research results

Prevalence of persistent H. pylori infection was 53.4% (95%CI: 45.7%-65.8%) in our population of 163 adults. Mean age was 40.8 ± 14.0 years, and 98 (60.1%) were female. Nutrient intake did not differ significantly between H. pylori positive and negative patients, neither did BMI. We observed significantly lower serum ghrelin levels in infected patients [median 311.0 pg/mL (IQR 230.0-385.5)] than in uninfected ones [median 355.0 pg/mL (IQR 253.8-547.8)] (P = 0.025), even after adjusting for BMI and gender (P = 0.03). A tendency towards lower ghrelin levels could be detected from antrum and corpus cagA positive patients; however, differences with cagA negative patients did not reach statistical significance (P = 0.50 and P = 0.49, respectively). Lower serum ghrelin concentration was associated with the type and severity of gastric pathology in the corpus (P = 0.04), independently of H. pylori status. Serum leptin levels did not differ significantly between H. pylori positive and negative patients [median 1.84 ng/mL (0.80-4.85) vs 1.84 ng/mL (0.50 - 5.09), (P = 0.51)].

Research conclusions

Our study demonstrated that H. pylori infection and the severity of gastric pathology of the corpus are associated with lower ghrelin serum concentrations. We also observed lower, but not significantly different ghrelin levels in patients carrying cagA positive strains, an observation that should be evaluated further in future studies.

Research perspectives

Our conclusions highlight the importance of investigating the effect of H. pylori eradication on ghrelin circulating levels regarding the genotype of infecting strains.