EFFECT OF HELICOBACTER PYLORI ERADICATION ON HEPATIC STEATOSIS, NAFLD FIBROSIS SCORE AND HSENSI IN PATIENTS WITH NONALCOHOLIC STEATOHEPATITIS: a MR imaging-based pilot open-label study

Abstract

Context Limited clinical data suggest Helicobacter pylori (Hp) infection may contribute to nonalcoholic fatty liver disease (NAFLD) pathogenesis. Objectives The effect of Hp eradication on hepatic steatosis (magnetic resonance imaging), nonalcoholic fatty liver disease fibrosis score and HSENSI (Homocysteine, serum glutamic oxaloacetic transaminase, Erythrocyte sedimentation rate, nonalcoholic steatohepatitis Index) in nonalcoholic steatohepatitis patients. Methods Thirteen adult patients with biopsy-proven nonalcoholic steatohepatitis, asymptomatic for gastrointestinal disease, underwent 13C urea breath test; Hp positive patients received eradication therapy until repeat test become negative. Hepatic fat fraction, standard biochemical tests and calculation of nonalcoholic fatty liver disease fibrosis score and HSENSI were performed at baseline and month 12. Results Hepatic fat fraction was similar for between and within group comparisons. Nonalcoholic fatty liver disease fibrosis score showed a non-significant trend towards decrease in Hp(+) [-0.34 (-1.39-0.29) at baseline and -0.24 (-0.99-0.71) at month 12; P = 0.116], whereas increase in Hp(-) group [-0.38 (-1.72-0.11) and -0.56 (-1.43-0.46), respectively; P = 0.249]. HSENSI was significantly decreased only in Hp(+) group [1.0 (1.0-2.0) at baseline and 1.0 (0-1.0) at month 12; P = 0.048]. Conclusions Hp eradication had no long-term effect on hepatic steatosis, but showed a trend towards improvement in nonalcoholic fatty liver disease fibrosis score and HSENSI. These results warrant larger studies with paired biopsies.

Extragastric Diseases and Helicobacter pylori

“…The same authors also reported that patients with NAFLD had higher anti-H. pylori IgG titers, together with lower circulating adiponectin and higher tumor necrosis factor (TNF)-a levels (which all contribute to NAFLD pathogenesis), compared to non-NAFLD individuals [21]. Furthermore, still Polyzos et al [22] recently showed that, in a small group of patients with biopsy-proven nonalcoholic steatohepatitis, although H. pylori eradication had no long-term benefit on hepatic steatosis, a trend toward improvement was observed in the NAFLD fibrosis score and HSENSI (homocysteine, serum glutamic oxaloacetic transaminase, erythrocyte sedimentation rate, nonalcoholic steatohepatitis index), thereby warranting further relative investigation with larger studies using paired biopsies.…”

“…Furthermore, still Polyzos et al. recently showed that, in a small group of patients with biopsy‐proven nonalcoholic steatohepatitis, although H. pylori eradication had no long‐term benefit on hepatic steatosis, a trend toward improvement was observed in the NAFLD fibrosis score and HSENSI (homocysteine, serum glutamic oxaloacetic transaminase, erythrocyte sedimentation rate, nonalcoholic steatohepatitis index), thereby warranting further relative investigation with larger studies using paired biopsies.…”

The Possible Role of Helicobacter pylori Infection in Non-alcoholic Fatty Liver Disease

“…It further supports the significance of H. pylori infection in the development of NAFLD. However, there were some studies declared that H. pylori infection is not related to NAFLD (Polyzos et al, 2014; Okushin et al, 2015; Baeg et al, 2016). In recent years, two studies from Korea and Japan involved 3,663 and 13,737 patients, respectively, found that H. pylori infection was not associated with NAFLD and may not be the risk factor for NAFLD (Okushin et al, 2015; Baeg et al, 2016).…”

Helicobacter pylori infection and nonalcoholic fatty liver disease: Time for large clinical trials evaluating eradication therapy

“…Improved liver function tests (ALT and gamma‐glutamyl transferase [GGT]), hepatic steatosis (assessed with liver ultrasonography and the noninvasive fatty liver index [FLI]), and IR (assessed with HOMA‐IR) were reported in a man 2 months after successful eradication of H pylori ‐I . Likewise, we performed a pilot, 12‐month open‐label study evaluating the effect of H pylori eradication treatment on hepatic fat fraction (evaluated by magnetic resonance imaging) and noninvasive indices of fibrosis and NASH (NAFLD fibrosis score and homocysteine, serum AST, erythrocyte sedimentation rate, nonalcoholic steatohepatitis index [HSENSI], respectively) in biopsy‐proven NAFLD patient with H pylori ‐I, whereas noninfected NAFLD patients served as controls . We showed no effect of H pylori eradication on hepatic steatosis, but a trend toward improvement in noninvasive indices of fibrosis and NASH.…”