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Some preliminary studies have suggested that patients with Helicobacter pylori infection are less likely to have inflammatory bowel disease (IBD) than the general population.
To investigate this possibility further, investigators used a large national database of surgical pathology reports to examine biopsy results for patients who underwent both upper endoscopy and colonoscopy on the same day. The results from gastroscopy specimens were reviewed for the presence of esophagitis, gastritis, and H. pylori infection; those from colonoscopy specimens were evaluated for the presence of ulcerative colitis (UC), Crohn disease (CD), and indeterminate colitis.
IBD was identified in 1061 (1.6%) of 65,515 patients; the remaining patients were used as controls. The associations between H. pylori infection and IBD as well as between non–H. pylori gastritis and IBD were evaluated using multivariate logistic regression, with adjustment for potential confounders.
The presence of H. pylori infection was inversely associated with diagnosis of any IBD (adjusted odds ratio, 0.53; 95% confidence interval, 0.39–0.70), CD (AOR, 0.48; 95% CI, 0.27–0.79), UC (AOR, 0.59; 95% CI, 0.39–0.84), and indeterminate colitis (AOR, 0.43; 95% CI, 0.15–0.95). Conversely, the presence of non–H. pylori chronic gastritis was positively associated with these diagnoses: any IBD (AOR, 5.61; 95% CI, 4.35–7.14), CD (AOR, 11.06; 95% CI, 7.98–15.02, UC (AOR, 2.25; 95% CI, 1.31–3.60), and indeterminate colitis (AOR, 6.91; 95% CI, 3.50–12.30).
Sonnenberg A and Genta RM. Low prevalence of Helicobacter pylori infection among patients with inflammatory bowel disease. Aliment Pharmacol Ther 2012 Feb; 35:469.
Comment
This well-designed study confirms suggestions that patients with H. pylori infection are at decreased risk for IBD. This finding, along with the positive association between non–H. pylori gastritis and IBD, raises questions about the mechanism underlying these associations. It should be noted that the prevalence of H. pylori infection was only 9% in the cohort overall, and even lower in the younger age groups. This might reflect the decreasing prevalence of the infection in the U.S. population or a potential selection bias. Less than 1% of the patients had no insurance, 3% were covered by Medicaid, and 69% had private insurance. Underrepresentation of patients from lower economic groups might have reduced the prevalence of H. pylori infection and introduced the possibility that the findings are due to factors associated with higher economic status.