Helicobacter pylori May Play a Contributory Role in the Pathogenesis of Primary Sclerosing Cholangitis

Abstract

Helicobacter pylori (H. pylori) DNA has been identified in human livers and has been implicated in chronic liver disease and liver cancer. To better understand the role of H pylori in primary sclerosing cholangitis (PSC), 25 patients with end-stage PSC and 31 controls were studied. Genomic DNA was extracted from microdissected hilar hepatic ducts of liver explants and was amplified for H pylori DNA. Serum was tested for H pylori antibodies. Helicobacter DNA was detected in 9 of the 56 (16%) patients by 16SrRNA PCR (an additional case [for a total of 18%] was antibody positive). Seven of the 9 cases identified by polymerase chain reaction were positive for the CagA gene, confirming they were H pylori. Seven of the 25 (28%) patients with PSC and 3 of the 31 (9.7%) controls were positive for Helicobacter (P=.087). H pylori DNA was detected in microdissected hilar biliary epithelium in more PSC patients than controls, supporting the hypothesis that bile reflux from the duodenum into the biliary tract might carry H pylori organisms into the proximal biliary system, possibly contributing to PSC development and/or progression in some patients.

Clinical features of primary sclerosing cholangitis with onset age above 50 years

“…Such assertion, however, is diffi cult because the concept of eosinophilic cholangitis is still confused, and some papers seem to report IgG4-related SC with eosinophilia as eosinophilic cholangitis. 17,18 We also examined H. pylori infection, which is a possible pathogenesis of PSC, 19 We are skeptical of the pathogenicity of H. pylori, however, because infection was recognized in only two patients in the older group.…”

Detection of Helicobacter pylori in Paraffin-Embedded Specimens from Patients with Chronic Liver Diseases, Using the Amplification Method

“…have been reported by Fox et al [10], who have shown the presence of H. bilis and H. pullorum in the bile of Chilean patients with chronic cholecystitis. Recently, Helicobacter DNA has been found in the liver of patients with different chronic liver diseases (CLD), such as primary sclerosing cholangitis (PSC) [11], hepatocellular carcinoma (HCC) [12], hepatitis C virus (HCV)-related chronic hepatitis, and cirrhosis [13,14]. CLD is an inflammatory disease and each inflammatory process is characterized by increased levels of pro-inflammatory cytokines, such as interleukins 1 and 6 (IL-1 and IL-6), tumor necrosis factor (TNF), and by the presence of lympho-mono cellular infiltrate and lymphoid follicle formation [12].…”

Mutation of iceA in Helicobacter pylori compromised IL‐8 induction from human gastric epithelial cells

“…H. pylori infect more than 50% of humans globally with a prevalence of 25% in the developed countries and more than 90% in the developing countries [1]. It has been generally accepted that H. pylori cause gastric and duodenal ulcer diseases, primary B-cell gastric lymphoma, and sclerosing cholangitis [2,3]. H. pylori virulence factors play an important role as the virulent strains of H. pylori increase the risk of developing more severe clinical manifestations.…”