H. pylori linked to hepatitis B progression
There is a high rate of Helicobacter pylori (H. pylori) infection in individuals with chronic hepatitis B and related cirrhosis, according to a meta-analysis from China.
In patients with chronic hepatitis B only (without cirrhosis or hepatocellular carcinoma [HCC]), the rate of H. pylori was twice that of healthy controls (pooled odds ratio [OR], 2.44, 95 percent confidence interval [CI], 1.85‒3.24; p<0.01) whereas patients with both chronic hepatitis B and cirrhosis had a fourfold rate of H. pylori compared with healthy controls (pooled OR, 4.28, 95 percent CI, 2.99‒6.13; p<0.01). [Int J Infect Dis 2016;50:30-37]
In patients with chronic hepatitis B-related HCC, the rate of H. pylori infection was six times higher than that of healthy controls, though this result was insignificant (pooled OR, 6.02, 95 percent CI, 4.33‒8.37; p=0.821).
Overall, there was a higher incidence of H. pylori in patients with chronic hepatitis B compared with those without chronic hepatitis B (pooled OR, 3.17, 95 percent CI, 2.38‒4.22; p<0.01).
“The results of this study revealed that H. pylori infection is positively associated with chronic hepatitis B and particularly with hepatitis B virus (HBV)-related cirrhosis and HBV-related HCC,” said the study authors. “These results [also] highlight the urgent need for H. pylori eradication. It is vital to screen patients with chronic hepatitis B for H. pylori infection.”
Study subjects were 2,977 patients with chronic hepatitis B who were compared with 1,668 healthy individuals (control arm). Data was obtained from studies published between 1994 and 2015.
The researchers acknowledged that using only case-control studies in this analysis was a limitation and called for randomized controlled trials to be conducted to investigate the link between H. pylori and hepatitis B-related cirrhosis and HCC. Furthermore, as the studies included were all conducted in China, the findings may not extend to other populations, they said.
Being a meta-analysis, findings from this study may not necessarily change current clinical practice, said Dr Ang Tiing Leong, chief and senior consultant in gastroenterology and hepatology at Changi General Hospital, Singapore, who was not affiliated with the study.
“This study is a meta-analysis of case-control studies that suggested an association between H. pylori and hepatitis B, in particular hepatitis B progression. No definitive conclusion can be drawn from this study. The only way would be to conduct a prospective randomized study,” he said.
“In reality, the general consensus is to eradicate H. pylori infection in all patients. It has been proven that this reduces the incidence of gastric cancer and occurrence of peptic ulcer disease. There are some who do not advocate H. pylori eradication in asymptomatic individuals in regions with low incidence of gastric cancer, due to theoretical concern of aggravating reflux disease and related complications, but this is contentious,” said Ang, on the steps necessary to reduce the incidence of H. pylori-related complications.