<i>H. pylori</i> Infection and Visceral Hypersensitivity in Patients with Irritable Bowel Syndrome

Abstract

Background/Aim: Irritable bowel syndrome (IBS) is characterized by abdominal pain and changes in stool habits. Visceral hypersensitivity (VH) is a key factor in the pathophysiology of IBS. The role of Helicobacter pylori infection in the induction of VH in the upper gastrointestinal tract is controversially discussed. The aim of this study is to evaluate the value of rectal barostat in eliciting abdominal symptoms in patients with IBS in relation to H. pylori infection. Patients and Methods: 31 patients (19 female, 12 male, mean age 45.6 ± 10 years) with normal colonoscopy and clinical signs of IBS were examined by rectal barostat (pressure-controlled balloon distension in the rectum). Induction of typical abdominal discomfort (far from the balloon) defined the examination positive. Level of nonpainful perception (L1), feeling of defecation (L2), and pain or stool urgency (L3) were registered in comparison with a healthy control group (CG; n = 15, 9 female, 6 male). The H. pylori status was defined by ¹³C-urea breath test (n = 46). Results: Typical abdominal discomfort was induced in 9 patients (pain group, PG) by pressure-controlled rectal distension (H. pylori status: 8 positive, 1 negative). Patients not presenting with abdominal pain to rectal distension (nonpain group, NPG) were all H. pylori negative (p < 0.001). L3 as an indicator of VH was reached at a lower pressure threshold in PG than in NPG or CG (p < 0.05). The perception was not different between NPG and CG (p > 0.05). Conclusions: The induction of typical abdominal discomfort in patients with IBS by the use of rectal barostat occurred predominantly in H. pylori infected patients and suggests that H. pylori infection may be involved in triggering VH in patients with IBS. Further studies in larger patient groups and after H. pylori eradication therapy are needed to confirm and extend this observation.

Brain-gut axis in the pathogenesis ofHelicobacter pyloriinfection

“…As a gastric mucosa-colonizing microorganism, H. pylori may contribute to the bidirectional nature of the brain-gut axis as evidenced by: (1) the overlapping of upper and lower digestive tract functional symptoms in H. pylori infected patients [18,[41][42][43] and the effect of H. pylori infection on IBS symptoms [43] (but see Breckan et al [44] ) and pancreatic juice secretion [45] ; (2) the protection against IBD appearance by H. pylori infection [17,46] resulting from changes induced in brain-gut axis function (neuroendocrine-immune crosstalk) [6,15,21,22,26,47,48] ; (3) the association of H. pylori infection with ANS-related extra-digestive diseases, such as atherosclerosis or cardiac arrhythmia [3,35] ; (4) the improved physical and psychological health-related quality of life and sexual relationships after digestive tract symptom alleviation and H. pylori eradication [49,50] ; (5) the proposed association between H. pylori infection and the development of axonal type Guillain-Barré neuropathy, multiple sclerosis and epilepsy [51][52][53] , and case reports of gastric MALT lymphoma followed by primary CNS lymphoma [54] ; and (6) the modulation of ANS balance by H. pylori infection [35] . Furthermore, H. pylori can potentially regulate esophageal motility [55] , gastric emptying, gastric accommodation of ingested food, gastric acid secretion, mucosal blood flow, hypersensitivity to chemoand mechano-stimulants [56] , food intake [6,19] , digestive tract endocrine and immune functions and the composition of gut microbiota [6,18,21,22] , by influencing the release of various neurotransmitters, including acetylocholine (vagal nerve, parasympathetic part), noradrenaline, adrenaline and sympathetic dopamine, as well as the neuropeptides leptin, ghrelin, calcitonin gene-related peptide (CGRP), nitric oxide, neuropep...…”

H. Pylori Infection is Associated with Development of Irritable Bowel Syndrome

“…This fact suggests that this bacterium may be involved in triggering abdominal pain. 20 Finally, the US Food and Drug Administration approved rifaximin, a nonabsorbable antibiotic, for the treatment of IBS with predominant diarrhea. In two large clinical trials, 2 weeks of treatment with rifaximin (550 mg, three times daily) in patients with nonconstipated IBS resulted in significantly more patients reporting adequate relief of global IBS symptoms and bloating during the first 4 weeks of follow-up.…”

Recurrent Abdominal Pain in Children: Is it Organic or Functional?

“…4,[6][7][8]14 Çalışmamızda en sık saptanan FGİB, fonksiyonel karın ağrısı (%62,9) olmuştur ve, literatürde bildirilenin aksine İBS sıklığı (%2,9) daha düşük bulunmuştur. Fonksiyonel dispepsi (%19,1), fonksiyonel kabızlık (%17,6) ve abdominal migren (%4,4) ise literatürdeki verilerle benzerlik göstermektedir.…”

“…[15][16][17][18][19][20] Kronik gastrik inflamasyonun sitokin salınımı aracılığı ile viseral hiperaljeziye yol açtığı ve H. pylori'nin rektoviseral gastrokolonik refleksin tetiklenmesinde rol alabileceği düşünül-mektedir. 8 Ülkemizde sağlıklı çocuklarda H. pylori sıklığı 13 C-üre nefes testi ile %50-56 olarak bulunmuştur, TKA'sı olan çocukların %36-49'unda ise H. pylori organik neden olarak bildirilmiştir. [21][22][23][24] Çalışmamızda TKA olan çocuklardaki H. pylori sıklığı %46 olup, diğer çalışmalarla benzer bulunmuştur ve toplum prevalansından yüksek değildir.…”

“…[3][4][5] Avrupa'da çocuklarda fonksiyonel karın ağrısının en sık nedeni olarak irritabl barsak sendromu (İBS) bildirilirken, gelişmekte olan ülkelerde TKA olan çocukların %30'unda organik bir neden saptanmıştır. [6][7][8] Organik nedenler dışlandığında FGİB tanısına yönelinmektedir. Birçok farklı çalışmada, gastrointestinal parazitozlar, inflamatuar barsak hastalığı, çölyak hastalığı, Helicobacter pylori enfeksiyonu, üriner sistem enfeksiyonları, laktoz intoleransı, fruktoz intoleransı ve besin allerjilerinin TKA'ya yol açabilecek organik bir neden olabileceği kabul edilmiş; ancak hangi testin ne zaman, kime uygulanması gerektiği konusunda henüz bir fikir birliğine varılamamıştır.…”