Helicobacter pylori ve inflamatuvar bağırsak hastalığı arasındaki ilişki

Öz

Giriş ve Amaç: Kronik Helicobacter pylori enfeksiyonunun, sistematik immün toleransı indükleyerek ve inflamatuvar tepkileri baskılayarak inflamatuvar bağırsak hastalığına karşı korumada bir rol oynadığı ileri sürülmektedir. Çalışmanın birincil amacı inflamatuvar bağırsak hastalığı olgularında Helicobacter pylori sıklığını saptamaktır. İkincil amacı ise inflamatuvar bağırsak hastalığı ve Helicobacter pylori enfeksiyonu arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntem: İnflamatuvar bağırsak hastalığı tanısı ile takip edilen, dispepsi nedeni ile üst gastrointestinal sistem endoskopisi yapılan 18 yaş üzeri hastaların verileri retrospektif olarak incelenerek olgular çalışmaya dahil edildi. Kontrol grubu inflamatuvar bağırsak hastalığı tanısı olmayan ve dispepsi nedeni ile üst gastrointestinal sistem endoskopisi yapılan olgulardan oluşturuldu. Tüm hastaların yaş, cinsiyet, üst gastrointestinal sistem endoskopide alınan biyopsi örneklerinin patolojik değerlendirme sonucundaki Helicobacter pylori varlığı, atrofik gastrit ve intestinal metaplazi varlığı bulguları kaydedildi. Her iki grup Helicobacter pylori sıklığı ve histopatolojik bulgular (intestinal metaplazi ve atrofik gastrit varlığı) yönünden karşılaştırıldı. Bulgular: Yüz altmış inflamatuvar bağırsak hastası ve 60 kontrol olmak üzere toplam 220 olgu çalışmaya dahil edildi. İnflamatuvar bağırsak hastalığı olgularının %53.8’i (n=86) ülseratif kolit, %46.2’si (n=74) Crohn hastalığı tanılı olgulardı. İnflamatuvar bağırsak hastalığı grubunda Helicobacter pylori oranı kontrol grubu ile karşılaştırıldığında anlamlı olarak daha düşük saptandı (%52.5’e karşı %73.3 ve p = 0.005). İnflamatuvar bağırsak hastalığı grubunda atrofik gastrit oranı kontrol grubu ile karşılaştırıldığında anlamlı olarak daha düşük bulundu (%3.1’e karşı %15 ve p = 0.001). İnflamatuvar bağırsak hastalığı grubunda intestinal metaplazi oranı kontrol grubu ile karşılaştırıldığında anlamlı olarak daha düşüktü (%1.9’a karşı %11.7 ve p = 0.002). Sonuç: İnflamatuvar bağırsak hastalığı grubunda anlamlı olarak daha düşük oranda Helicobacter pylori pozitifliği saptanmıştır. Aynı şekilde, inflamatuvar bağırsak hastalığı grubunda daha düşük oranda atrofik gastrit ve intestinal metaplazi varlığı saptanmıştır. İnflamatuvar bağırsak hastalığı olgularında tedavide kullanılan antibiyotiklerin Helicobacter pylori sıklığını azaltarak daha az sıklıkta atrofik gastrit ve intestinal metaplazi gelişimine yol açtığını düşünmekteyiz.

Anahtar Kelimeler

• Crohn hastalığı
• Helicobacter pylori
• inflamatuvar bağırsak hastalığı
• ülseratif kolit

Relationship between Helicobacter pylori infection and inflammatory bowel disease

Öz

Background and aims: It has been suggested that chronic Helicobacter pylori infection plays a protective role against inflammatory bowel disease by inducing systemic immune tolerance and suppressing inflammatory responses. The primary aim of the study was to determine the frequency of Helicobacter pylori in inflammatory bowel disease patients. A secondary aim was to investigate the relationship between inflammatory bowel disease and Helicobacter pylori infection. Materials and Methods: Patients over 18 years of age who were in follow-up with a diagnosis of inflammatory bowel disease and who underwent upper gastrointestinal system endoscopy for dyspepsia were included in the study and their data retrospectively analyzed. The control group consisted of patients who were not diagnosed with inflammatory bowel disease and had upper gastrointestinal system endoscopy for dyspepsia. For all patients, age; gender; and the presence of Helicobacter pylori, atrophic gastritis, and intestinal metaplasia as a result of pathological evaluation of biopsy samples taken by upper gastrointestinal system endoscopy were recorded. Both groups were compared in terms of Helicobacter pylori frequency and histopathological findings (presence of intestinal metaplasia and atrophic gastritis). Results: A total of 220 cases, including 160 inflammatory bowel disease and 60 controls, were included in the study. In all, 53.8% (n = 86) of inflammatory bowel disease patients were diagnosed with ulcerative colitis and 46.2% (n = 74) with Crohn’s disease. The rate of Helicobacter pylori was found to be significantly lower in the inflammatory bowel disease group compared with the control group (52.5% versus 73.3% and p = 0.005). The rate of atrophic gastritis was significantly lower in the inflammatory bowel disease group compared with the control group (3.1% vs 15% and p = 0.001). The intestinal metaplasia rate was significantly lower in the inflammatory bowel disease group compared with the control group (1.9% vs 11.7% and p = 0.002). Conclusion: Helicobacter pylori positivity was found at a significantly lower rate in the inflammatory bowel disease group. The presence of atrophic gastritis and intestinal metaplasia was found to be lower in the inflammatory bowel disease group. We believe that antibiotics used in the routine treatment of inflammatory bowel disease patients decrease the frequency of Helicobacter pylori and lead to less frequent development of atrophic gastritis and intestinal metaplasia.

Anahtar Kelimeler

• Crohn
• Helicobacter pylori
• inflammatory bowel disease
• ulcerative colitis

Kaynakça

1. 1. Bravo D, Hoare A, Soto C, Valenzuela MA, Quest AF. Helicobacter pylori in human health and disease: Mechanisms for local gastric and systemic effects. World J Gastroenterol 2018;24:3071-89.
2. 2. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011;61:212-36.
3. 3. Watari J, Chen N, Amenta PS, et al. Helicobacter pylori associated chronic gastritis, clinical syndromes, precancerous lesions, and pathogenesis of gastric cancer development. World J Gastroenterol 2014;20:5461-73.
4. 4. Correa P. Human gastric carcinogenesis: a multistep and multifactorial process--First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res 1992;52:6735-40.
5. 5. Schistosomes, liver flukes and Helicobacter pylori. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Lyon, 7-14 June 1994. IARC Monogr Eval Carcinog Risks Hum 1994;61:1-241.
6. 6. Weck MN, Brenner H. Association of Helicobacter pylori infection with chronic atrophic gastritis: Meta-analyses according to type of disease definition. Int J Cancer 2008;123:874-81.
7. 7. Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 2004;126:1504-17.
8. 8. Quetglas EG, Mujagic Z, Wigge S, et al. Update on pathogenesis and predictors of response of therapeutic strategies used in inflammatory bowel disease. World J Gastroenterol 2015;21:12519-43.

9. 9. El-Omar E, Penman I, Cruikshank G, et al. Low prevalence of Helicobacter pylori in inflammatory bowel disease: association with sulphasalazine. Gut 1994;35:1385-8.
10. 10. Pearce CB, Duncan HD, Timmis L, Green JR. Assessment of the prevalence of infection with Helicobacter pylori in patients with inflammatory bowel disease. Eur J Gastroenterol Hepatol 2000;12:439-43.
11. 11. Piodi LP, Bardella M, Rocchia C, et al. Possible protective effect of 5-aminosalicylic acid on Helicobacter pylori infection in patients with inflammatory bowel disease. J Clin Gastroenterol 2003;36:22-5.
12. 12. Triantafillidis JK, Gikas A, Apostolidiss N, et al. The low prevalence of Helicobacter infection in patients with inflammatory bowel disease could be attributed to previous antibiotic treatment. Am J Gastroenterol 2003;98:1213-4.
13. 13. Ozaydin N, Turkyilmaz SA, Cali S. Prevalence and risk factors of Helicobacter pylori in Turkey: a nationally-representative, cross-sectional, screening with the ¹³C-Urea breath test. BMC Public Health 2013;13:1215.
14. 14. Caner S, Altinbaş A, Yeşil Y, et al. The relation between Helicobacter pylori and ulcerative colitis. Turk J Med Sci 2014;44:820-3.
15. 15. D’Incà R, Sturniolo G, Cassaro M, et al. Prevalence of upper gastrointestinal lesions and Helicobacter pylori infection in Crohn’s disease. Dig Dis Sci 1998;43:988-92.
16. 16. Parente F, Molteni P, Bollani S, et al. Prevalence of Helicobacter pylori infection and related upper gastrointestinal lesions in patients with inflammatory bowel diseases. A cross-sectional study with matching. Scand J Gastroenterol 1997;32:1140-6.
17. 17. Castaño-Rodríguez N, Kaakoush NO, Lee WS, Mitchell HM. Dual role of Helicobacter and Campylobacter species in IBD: a systematic review and meta-analysis. Gut 2015 Oct 27. pii: gutjnl-2015-310545.
18. 18. Roka K, Roma E, Stefanaki K, et al. The value of focally enhanced gastritis in the diagnosis of pediatric inflammatory bowel diseases. J Crohns Colitis 2013;7:797-802.
19. 19. Sonnenberg A, Melton SD, Genta RM. Frequent occurrence of gastritis and duodenitis in patients with inflammatory bowel disease. Inflamm Bowel Dis 2011;17:39-44.
20. 20. Halme L, Kärkkäinen P, Rautelin H, Kosunen TU, Sipponen P. High frequency of helicobacter negative gastritis in patients with Crohn’s disease. Gut 1996;38:379-83.
21. 21. Kayali S, Gaiani F, Manfredi M, et al. Inverse association between Helicobacter pylori and inflammatory bowel disease: myth or fact? Acta Biomed 2018;89(9-S):81-6.
22. 22. Wu XW, Ji HZ, Yang MF, Wu L, Wang FY. Helicobacter pylori infection and inflammatory bowel disease in Asians: a meta-analysis. World J Gastroenterol 2015;21:4750-6.
23. 23. Lin KD, Chiu GF, Waljee AK, et al. Effects of anti-Helicobacter pylori therapy on incidence of autoimmune diseases, including inflammatory bowel diseases. Clin Gastroenterol Hepatol 2019;17:1991-9.
24. 24. Pellicano R, Ianiro G, Fagoonee S, Settanni CR, Gasbarrini A. Review: Extragastric diseases and Helicobacter pylori. Helicobacter 2020;25(Suppl 1):e12741.
25. 25. Prónai L, Schandl L, Orosz Z, Magyar P, Tulassay Z. Lower prevalence of Helicobacter pylori infection in patients with inflammatory bowel disease but not with chronic obstructive pulmonary disease - antibiotic use in the history does not play a significant role. Helicobacter 2004;9:278-83.
26. 26. Harbord M, Eliakim R, Bettenworth D, at al; European Crohn’s and Colitis Organisation [ECCO]. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 2: Current Management. J Crohns Colitis 2017;11:769-84.
27. 27. Gomollón F, Dignass A, Annese V, et al; ECCO. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: Diagnosis and Medical Management. J Crohns Colitis 2017;11:3-25.
28. 28. Malfertheiner P, Megraud F, O'Morain CA, et al; European Helicobacter and Microbiota Study Group and Consensus panel. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut 2017;66:6-30.
29. 29. Kim N. Chemoprevention of gastric cancer by Helicobacter pylori eradication and its underlying mechanism. J Gastroenterol Hepatol 2019;34:1287-95.