Helicobacter pylori infection in patients affected by raynaud phenomenon: Beneficial effects of eradication

Abstract

Recent studies have suggested that H. pylori infection may be associated with primary Raynaud phenomenon (PRP), a functional vascular disorder defined by an intermittent vasospasm of the arterioles of the distal limbs which occurs mostly following exposure to cold or emotional stimuli. Aim of this study was to assess the effects of H. pylori eradication in patients (pts) affected by PRP. METHODS: 46 pts (45 females and 1 male; mean age 37 ± 17 years) affected by PRP were evaluated. PRP was defined by the clinical manifestations of the attacks and by the amplitude of the digital plethysmographic signals measured in basal condition and after cold test. Discomfort feeling, duration and frequency of clinical attacks of PRP per week were assessed in the month preceding admission. H. pylori infection was diagnosed by 13C urea breath-test. The cytotoxins CagA and VacA were detected by Western Blot analysis in infected pts. Triple therapy consisting of amoxicillin (500 mg qid), clarithromycin (250 rid) and lansoprazole (30 mg bid) was given to H. pylori positive pts at the time of diagnosis for 7 days. Control of eradication was assessed after 6 weeks of finishing treatment. Clinical attacks of PRP per week were assessed after 6 and 12 weeks from finishing treatment. Non-infected pts affected by PRP were utilized as a control group. RESULTS: 78% (36 out of 46; mean age 38 ± 14 years) of pts affected by PRP remained infected by H. pylori. CagA and VacA were present in 86 and 76% of positive pts, respectively. No significant differences were found in discomfort feeling, duration and frequency of clinical attacks of PRP per week between infected and non-infected pts at the time of enrollment. 83% of infected pts were eradicated after therapy. 5 out of the 30 eradicated pts studied (17%) presented a complete disappearance of the clinical attacks of PRP during the follow up period. Discomfort feeling, duration and frequency of the attacks were significantly reduced in 72% of the remaining pts (18 out of 25 pts). Conversely, features of clinical attacks of PRP did not change significantly during the follow up in the control group of not infected PRP pts. CONCLUSIONS: this study confirm that H. pylori infection is extremely common in pts affected by PRP. CagA and VacA strains of the bacterium appear to be highly prelevant in infected pts. H. pylori eradication causes a marked reduction of the clinical symptoms of PRP. The multiplicity of substances produced, directly or indirectly, in response to H. pylori, such as cytokines and other cellular mediators of the acute phase response, could be involved in vessel dismotility of Raynaud phenomenon.