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Abstract
Background Helicobacter pylori infection has been associated with insulin resistance and non-alcoholic fatty liver disease (NAFLD). This study was done to evaluate the effect of H. pylori-eradication therapy (HPET) in patients with NAFLD compared to standard management therapy (SMT).MethodsEighty NAFLD patients with H. pylori co-infection were randomized into SMT (diet and exercise, n = 36) and HPET (SMT plus amoxicillin, clarithromycin, and pantoprazole, n = 44) groups. The controlled attenuation parameter (CAP), anthropometric parameters, liver enzymes, lipid profile, and glycemic parameters including homeostasis model assessment-insulin resistance (HOMA-IR) were measured and compared between two groups at the baseline and 24 weeks.ResultsSixty-four participants (SMT group [n = 28] and HPET group [n = 36]) were included in a modified intention-to-treat analysis. Both the SMT group and the HPET group had a significant reduction in CAP scores at 24 weeks (P = 0.002 and P < 0.001, respectively), but the change between the groups was insignificant (P = 0.213). Successful eradication of H. pylori occurred in 68% of the HPET group and led to greater improvement in HOMA-IR at 24 weeks compared to SMT or non-responder patients (P = 0.007). The liver enzymes reduced significantly at 24 weeks in both groups, but the changes between the groups were similar. The lipid parameters remained unchanged within the groups and between the groups at 24 weeks. A significant increase in the levels of reduced glutathione was noted in the HPET group, but the change between the two groups was not statistically different.ConclusionsHPET was found to be comparable to SMT alone in reducing hepatic steatosis and liver enzymes at 24 weeks in NAFLD patients. However, successful eradication of H. pylori led to greater improvement in HOMA-IR (Trial registration CTRI/2017/05/008608).
Highlights
Non-alcoholic fatty liver disease (NAFLD) is characterized by !5% of hepatic steatosis that occurs due to causes other than significant alcohol consumption, medications, viral etiology, and autoimmune etiology [1]
Successful eradication of H. pylori occurred in 68% of the H. pylori-eradication therapy (HPET) group and led to greater improvement in homeostasis model assessment-insulin resistance (HOMA-Insulin resistance (IR)) at 24 weeks compared to standard management therapy (SMT) or non-responder patients (P 1⁄4 0.007)
Because H. pylori has an impact on IR and metabolic syndrome, this study was conducted to evaluate the effect of H. pylori-eradication therapy (HPET) in patients with non-alcoholic fatty liver disease (NAFLD) compared to standard management therapy (SMT) without H. pylori eradication
Summary
Non-alcoholic fatty liver disease (NAFLD) is characterized by !5% of hepatic steatosis that occurs due to causes other than significant alcohol consumption, medications, viral etiology, and autoimmune etiology [1]. Because H. pylori has an impact on IR and metabolic syndrome, this study was conducted to evaluate the effect of H. pylori-eradication therapy (HPET) in patients with NAFLD compared to standard management therapy (SMT) without H. pylori eradication. Helicobacter pylori infection has been associated with insulin resistance and non-alcoholic fatty liver disease (NAFLD). This study was done to evaluate the effect of H. pylori-eradication therapy (HPET) in patients with NAFLD compared to standard management therapy (SMT). Successful eradication of H. pylori occurred in 68% of the HPET group and led to greater improvement in HOMA-IR at 24 weeks compared to SMT or non-responder patients (P 1⁄4 0.007). Conclusions: HPET was found to be comparable to SMT alone in reducing hepatic steatosis and liver enzymes at 24 weeks in NAFLD patients. Successful eradication of H. pylori led to greater improvement in HOMA-IR (Trial registration CTRI/2017/05/008608)
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