Should we Test Patients with Chronic Dysphagia for Enterohepatic Helicobacter Infection?

Abstract

AIM: It is recognized that Helicobacter species cause disease in the stomach and duodenum, however, the extent to which the enterohepatic cluster of this group of microorganisms may cause hepatobiliary disease is unknown. We aimed to explore the association between positive titers of anti-Helicobacter pylori immunoglobulin G, alanine aminotransferase levels and findings on upper endoscopy in patients with dyspeptic symptoms. MATERIAL AND METHODS: Medical records review of 408 patients from outpatient clinics with dyspeptic symptoms was performed. All patients had no history of liver disease. Liver function tests, serological tests including quantitative anti-Helicobacter pylori with a threshold of 1.1units/dL as a positive test, and endoscopy reports were reviewed up to 3 years prior to the Helicobacter antibody testing. Variables were created for each 3-month period preceding serologic test for Helicobacter infection. Statistical analysis using t-test, chi-square and Pearson correlation coefficients was performed. RESULTS: Patients who tested positive for Helicobacter pylori antibodies were more likely to have elevated alanine aminotransferase levels than patients with negative anti-Helicobacter pylori antibodies (10.5% vs 4.1%, p<0.05). Many patients with positive anti-Helicobacter pylori antibodies had unexpectedly low rate of gastric invasion by Helicobacter pylori, but noted to have a high rate of alanine aminotransferase elevation (34.3%). In contrast, patients with positive serology for Helicobacter pylori infection and positive mucosal biopsy for Helicobacter invasion had a lower rate of alanine aminotransferase elevation (15.4%). A correlation between elevated alanine aminotransferase levels and the anti-Helicobacter pylori antibody titers (r =0.17; p<0.01) was observed. CONCLUSION: These findings indicate that positive serological test for Helicobacter pylori infection may not be fully explained by invasion of gastric or duodenal mucosa alone. These data support the theory that Helicobacter species other than Helicobacter pylori may play a role in hepatobiliary diseases in humans.