Association of helicobacter pylori with multiple sclerosis: Protective or risk factor?

Abstract

Background: Multiple sclerosis (MS) is a common autoimmune inflammatory disease in the central nervous system (CNS) without exact pathology. Environmental factors such as infections have a causal or protective role in MS. Helicobacter pylori (HP) is one of the infections in digestive diseases and previous studies reported controversial findings of this infection role in MS. So, we conducted this study to assess the frequency of HP infection in patients with MS in comparison to the healthy population.
 Methods: This cross-sectional study was undertaken between 2015 and 2019. 191 participants including 58 patients with clinically isolated syndrome (CIS), 57 patients with relapsing-remitting MS (RRMS), 39 patients with secondary progressive MS (SPMS), and 39 age- and sex-matched healthy controls (HCs) were tested for the presence of HP immunoglobulin G (IgG) and IgM antibodies (Abs) in their serum sample.
 Results: The frequency of HP IgG seropositivity in patients with SPMS was significantly higher than patients with CIS [Odds ratio (OR): 6.333, 95% confidence interval (CI): 2.522-15.906, P < 0.001], patients with RRMS (OR: 4.583, 95% CI: 1.842-11.407, P = 0.001), and HCs (OR: 8.485, 95% CI: 3.058-23.540, P < 0.001). We did not find a significant difference among other study groups regarding IgG seropositivity. No significant difference among groups regarding HP IgM seropositivity was evident. On univariate model, Expanded Disability Status Scale (EDSS) score (OR: 1.038, 95% CI: 1.038-1.460, P = 0.017) and SPMS (OR: 4.583, 95% CI: 1.842-11.407, P = 0.001) were predictor for HP IgG seropositivity. On multivariate model, only SPMS had higher risk for HP IgG seropositivity compared to RRMS (OR: 5.554, 95% CI: 1.327-23.253, P = 0.019). We did not find a significant association between clinical and demographic variables with HP IgM seropositivity.
 Conclusion: Based on our findings, progressive MS and HP infection may have association. Further longitudinal studies with large sample size are needed to determine the role of HP infection in MS.

Helicobacter pylori infection and risk of multiple sclerosis: An updated meta‐analysis

“…Finally, 22 studies (25 datasets) met the predefined criteria for inclusion and subsequent meta-analysis. Of these, 17 datasets compromising 2606 cases and 2200 controls had prevalence data, 5,7,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] and eight datasets with 861 cases and 706 controls had data on mean IgG titers against H. pylori. 6,42,53,54,[57][58][59][60]…”

“…Twenty studies had case-control design, while two studies were cross-sectional. 6,7 Among studies included, seven were from Europe and North America regions (Greece, United Kingdom, and United States); ten were from Middle East and North Africa region (Iran, Iraq, and Egypt); four were from Western Pacific region (Japan, China, and Australia); and one was from South-east Asia region (India). Countries with most available studies were Iran (seven datasets) and Greece (five datasets).…”

“…Seventeen studies 5,7,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] provided data on H. pylori prevalence in cases and controls (Table 2). The pooled prevalence of H. pylori was 44.1% (95%CI, 32.76-55.52; 908/2606) in the MS cases and 46.1% (95%CI, 31.18-61.04; 1016/2200) in the controls, respectively, with an estimated OR of 0.82 and 95% CI of 0.58-1.17, indicating a non-significant protective effect of H. pylori on MS (Figure 2).…”

“…3,4 Despite the various treatment strategies presently used, such as interferon (a drug in the disease-modifying therapies class) prescription for inhibiting disease progression, faster diminishing of attacks, and reducing the bothersome symptoms of MS, 5 current therapeutic options for the treatment of MS remain inadequate. 6 Although the pathogenesis of MS remains to be fully understood, 7 this disease is associated mainly with complex interactions between genetic and environmental factors. 8,9 Linked to the "hygiene hypothesis," it has been speculated that infection with particular microorganisms, particularly those occurring in childhood, may have a protective effect against allergic and autoimmune diseases.…”

“…17,18 H. pylori is a spiral-shaped, microaerophilic, gram-negative bacteria that colonizes the stomach of humans. 18 It has been linked to a variety of gastric disorders, such as peptic ulcers, low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma, and gastric cancer, 7,19 and has also been associated with metabolic syndrome (MetS)-related systemic pathologies, especially cardiocerebrovascular, and neurodegenerative diseases, as endpoints of MetS. 20,21 It is estimated that about half of the world's population are exposed to H. pylori in their lifetime.…”