Gastritis Can Cause and Trigger Chronic Spontaneous Urticaria Independent of the Presence of <b><i>Helicobacter pylori</i></b>

Abstract

Background/Aim: In chronic spontaneous urticaria (CSU), Helicobacter pylori (HP) has been discussed as a cause, but it is unknown whether the bacterium itself or concomitant inflammation is causing the urticaria. Our aim was to investigate HP and upper gastrointestinal lesions as signs of inflammation independently of each other in the pathogenesis of CSU. Methods: A total of 36 prospectively enrolled CSU patients from Moscow were investigated by gastroscopy and screened for the presence of HP and/or upper gastrointestinal lesions. Those having a positive result were treated according to the Maastricht III recommended guidelines for eradication therapy, and success was assessed by a follow-up gastroscopy. Simultaneously, the activity of CSU was measured before and after therapy of the gastrointestinal condition. Results: HP was observed in 26 of the 36 patients. Erosions or ulcers were found in 18 of the 36 patients, 14 of whom were also positively tested for HP. There was a significant difference in improvement of urticarial symptoms between those who succeeded in healing the erosions and those who did not succeed (p < 0.01) independent of the presence of HP. No significant difference in symptom relief was observed between those who had successful eradication and those in whom HP eradication failed. Conclusions: Upper gastrointestinal inflammatory disorders can cause CSU and trigger exacerbations independently of HP. This might imply that also in HP-positive patients, urticaria is not based on an immunological reaction against the germ but rather on the underlying inflammation. These findings also strengthen the importance of a gastroenterological workup of patients with CSU.

Systematic review and meta‐analysis: Effect ofHelicobacter pylorieradication on chronic spontaneous urticaria

“…Among the 22 studies, a total of 1385 CSU patients, who were all assessed and diagnosed by dermatologists, were enrolled. The characteristics of the included studies are listed in Table .…”

“…[40][41][42][43] Moreover, enhanced gastric permeability may also play a role; CSU is associated with a pseudo-allergy to food and increased permeability of the gastric mucosa, since damage caused by HP may give rise to inappropriate immunorecognition of food allergens. 6,44 Zheleznov et al 29 amounts may remain and regrow at a later time. 54 The test used to detect eradication does not guarantee full and complete elimination of all bacteria.…”

“…Moreover, enhanced gastric permeability may also play a role; CSU is associated with a pseudo‐allergy to food and increased permeability of the gastric mucosa, since damage caused by HP may give rise to inappropriate immunorecognition of food allergens . Zheleznov et al reported significant differences in urticarial symptom improvement between those in whom erosions did and did not heal. Gastric mucosal inflammation itself may possibly be relevant.…”

“…Among the 22 [6][7][8][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] studies, a total of 1385 CSU patients, who…”

Recent Advances in Clinical Allergy and Immunology

“…As blood levels of NO x and nitrate are significantly higher in CSU patients compared to healthy controls, and correlate with disease activity, a pathogenic role of nitrosative stress has been suggested [64]. A recent study reported a frequent association of CSU with upper gastrointestinal inflammatory disorders with and without Helicobacter pylori infection, and an improvement of urticaria in parallel with a successful treatment of the gastrointestinal disorder [65]. In India, H. pylori infections, which are mainly asymptomatic, are also frequent in CSU patients; however, the implications for disease course and severity are not clear [66].…”