Eradication Therapy for Helicobacter pylori Improves Nutrition Status Depended on Severity of Gastric Mucosal Atrophy and Plasma Ghrelin Level in Japanese Hemodialysis Patients

Abstract

Introduction: The state of metabolic and nutritional derangement, called protein—energy wasting (PEW), has a major impact on mortality in hemodialysis (HD) patients. Ghrelin has multiple favorable functions and associates with the pathogenesis of PEW in HD patients. Plasma and gastric ghrelin levels are affected in H pylori status. Here, we investigated relationships among nutrition status, ghrelin level, H. pylori and severity of atrophy in HD patients and investigated the efficacy of H. pylori eradication therapy for improvement of nutrition status related with ghrelin in H. pylori—positive HD patients. Methods: H. pylori&#x2014;IgG and pepsinogen levels of 500 HD patients at 8 dialysis centers were measured. We classified H. pylori infectionstatus into three groups: present infection, past infection and non—infection. Plasma ghrelin levels were measured and we investigated above relationship among three groups. H. pylori—positives underwent endoscopy for evaluation of the severity of atrophy, and eradicated by PPI, amoxocollin and clarithromycin for 7days. We evaluated nutrition markers and ghrelin levels before and 1 year after eradication. Results: Acyl— and desacyl—ghrelin levels were 29.7±21.3 fmol/mland 279.2±168.5 fmol/ml, respectively. Acyl—ghrelin in the non—infection group was significantly higher than in the present and past infection groups. Acyl—ghrelin level was positively correlated with serum PG I level and PG I/II ratio and was significantly lower in patients with severe atrophy than in those with no atrophy (20.9±14.6and 40.4±21.9, p<0.001). Cholinesterase level was significantly increased after eradication compared with before eradication (303.2±76.0 vs. 287.3±68.1, p=0.029). In particular, cholesterol(before, 196.6±23.2; after, 206.1±25.9, p=0.042) and cholinesterase levels(before, 296.9±70.8; after, 316.4±73.8, p=0.049) increased more strongly in patients with mild-moderate atrophy than those with severe atrophy. Conclusion: Plasma ghrelin level was associated with endoscopic and serological severity of atrophy related with H. pylori infection in HD patients. Eradication improved nutrition status by increasing serum cholinesterase and cholesterol levels, especially those with mild and moderate gastric mucosal atrophy. In HD patients, eradication therapy may contribute to an improvement in prognosis associated with PEW.