The Association between Serum Vitamin D Levels and Helicobacter pylori Presence and Eradication.

Asher Shafrir,Lior H Katz,Michal Shauly-Aharonov,Zvi Ackerman,Ora Paltiel,Yishai Pickman

doi:10.3390/nu13010278

Abstract

Background: The success of Helicobacter pylori (H. pylori) eradication depends on several host and treatment factors. Serum vitamin D levels may be associated with H. pylori infection and eradication rates. We investigated the association between vitamin D and H. pylori infection and eradication, using a large electronic database based on medical records from a population-based health maintenance organization. Methods: Data regarding adults who underwent H. pylori testing and had vitamin D measurements within one month of H. pylori testing were collected. H. pylori infection was ascertained using urea breath or stool antigen tests. A negative H. pylori test following a positive result implied eradication. Multivariate regression models were constructed to assess associations between H. pylori infection, eradication, and vitamin D. Results: Among 150,483 members who underwent H. pylori testing from 2009 to 2018, 27,077 (18%) had vitamin D measurements. Vitamin D levels were inversely associated with H. pylori infection, p < 0.001. The odds of a positive H. pylori test were 31% higher among patients with vitamin D levels <20 ng/mL, compared with those with levels ≥20 ng/mL (OR 1.31, 99% CI 1.22–1.4, p < 0.001). Purchase of vitamin D supplements was associated with a negative subsequent H. pylori test (p < 0.001). Mean vitamin D levels were moderately higher in those with successful vs. failed H. pylori eradication (19.34 ± 9.55 vs. 18.64 ± 9.61, p < 0.001). Conclusions: Vitamin D levels are associated with H. pylori infection. Increased vitamin D levels are associated with successful H. pylori eradication. Vitamin D may have a role in H. pylori eradication.

Highlights

Multiple studies have shown that H. pylori infection is associated with chronic gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric cancer [1,2]
Patients were categorized as H. pylori positive or negative based on the results of their first test, according to the accepted normal values of the urea breath test (UBT) and stool antigen tests
A total of 258,626 tests were performed for the presence of H. pylori infection between

Summary

Introduction

Multiple studies have shown that H. pylori infection is associated with chronic gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric cancer [1,2]. The presence of seasonal variation in the frequency of upper gastrointestinal bleeding due to peptic ulcer disease, with rates higher in the winter and spring and lower in the summer, was reported [3]. Several hypotheses were raised to explain the seasonal variation in the clinical presentation and detection of H. pylori infection. These include seasonal changes in the immune system, nutritional status, and medication use [4]. Infection rates of H. pylori may depend on environmental factors, such as altitude, average annual temperature, and average daily sunshine [5], factors which may influence ultraviolet light intensity and exposure time and the synthesis of vitamin D [6]

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Results

Conclusion