The Role of Chronic Helicobacter Infection in Hepatobiliary Diseases

Abstract

Purpose: It is known that Enterohepatic Helicobacter species were identified in the liver tissue, the wall of the bile ducts, and bile. Clinical significance of the presence of bile-resistant Helicobacter spp. in the biliary tract and liver is unclear. We studied a specific pool of patients without any apparent evidence of liver disease, but with chronic gastrointestinal inflammation associated with Helicobacter infection with symptoms that presented for more than 6 months. Methods: A total of 89 patients out of 536 with chronic gastroduodenitis associated with H. Pylori infection were selected. Patients with known liver diseases were excluded from the study. Antibody responses to H. Pylori were evaluated with enzyme-linked immunoassay. Other studies included upper endoscopy with histological study for H. Pylori; abdominal ultrasound; complete biochemical panel; and hepatitis panel. Results: It was found that patients with chronic Helicobacter gastroduodenitis had relatively frequent changes in clinical and laboratory data, specifically increased liver echogenicity, wall thickness of extrahepatic biliary ducts and changes in hepatic transaminases. Most of the patients had a minimal to moderate elevation of transaminases. Majority of the patients (82.5 percent) had elevated levels of anti-Helicobacter IgG and 24.4 percent of the patients had elevated levels of anti-Helicobacter IgM. Total 44 percent of the patients had high anti-Helicobacter IgG levels with concomitant alanine aminotrasferase elevation. However, only a small number of patients with low anti-Helicobacter IgG levels (2.5 percent) had elevation of transminases. Non-specific ultrasound findings included thickening of the gall bladder wall in 89.8 percent of the patients and common bile duct in 33.7 percent. About half of the patients with chronic Helicobacter gastroduodenitis had increased liver echogenicity and elevated specific IgG levels at the same time. Conclusion: Patients with chronic Helicobacter infection that was confirmed by histological and immunological studies were found to have elevation of specific anti-Helicobacter IgG levels that were associated with ALT elevation and increased liver echogenicity as well as sonographic evidence of thickening of the gall bladder wall and extrahepatic bile ducts, indicating possible involvement of hepatobiliary system into the pathological process. There is no clear explanation of these findings, thus, subsequent larger studies are warranted in the future to explore the significance of anti-Helicobacter spp. antibody levels or a role of particular enterohepatic Helicobacter sp. in the pathogenesis of chronic changes in the hepatobiliary system.Table: [238] Overview of nonspecific findings on ultrasound and liver function panel in patients with chronic Helicobacter gastroduodenitis ( n =89)Table: [238] Frequency of alanine aminotransferase elevation in patients with different levels of anti-Helicobacter IgG, IgA, and IgM levels, n/percent