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Relationship between Helicobacter pylori infection, diabetes mellitus and gallstones ; fact or fictions?

BACKGROUND: Helicobacter pylori ( HP) infection currently is the most important etiologic agent in the development of chronic active gastritis, gastric and duodenal ulcers, carcinoma and Malt lymphoma of the stomach. Moreover, HP infection has also been associated with various extradigestive disease . Increased seroprevalence of HP infection in diabetes mellitus (DM) has been demonstrated by many investigators..The roleof HP infection in diabetic dispepsia is mainly related to blood glucose . Also, recent studies have revealed the presence of HP in the hepatobiliary system , suggesting that these bacteria are etiological importance in gallstone formation. AIM: of our study was to evaluate any relationship between Helicobacter pylori infection diabetes mellitus and gallstones. PATIENTS AND METHODS: In this study participated 66 dyspeptic patients with diabetes mellitus / 39 female and 27 male / mean age 63, 6 yrs. The patients divided into two groups. Group A: 34 dyspeptic patients with diabetes mellitus and galstones and Group B: 32 dyspeptic patients with diabetes mellitus but without gallsones. The both group of patientes were comparable in sex, age and body mass index. All patients had echosonography of upper stomach and upper gastro-intestinal endoscopy. The gastroduodenal pathology was indentified. HP infection was confirmed by gastric hystology. All patients were follow up clinicaly and with laboratory test. As metabolic control were measured fasting glucose and glucated haemoglobin (HbA1c), and was also observed duration of diabetes mellitus ( <1 yr, 1-3 yr, >3 yr ). A triple therapy with amoxycillin / 1gr b i d /, medazol /400 mg b i d /, pantoprazol /40 mg b i d as first cycle or amoxycillin /1gr b i d /, claritromycin /500 mg b i d / and lanzoprazol 30 mg b i d/ as second cycle (for patients in whom eradication was not successful in the first cycle) was given to both groups for 7 days. Cure was defined as the absence of HP infection 6 weeks after completing anti-mikrobial therapy and effects of HP eradication on gastrointestinal symptoms. RESULTS:A higher HP infection was found in group of patients with gallstones (76% ) versus 46% in patients without gallstones. P< 0.001. Its correlated with fasting glucose and HbA1c values and was directly related to the duration of diabetes mellitus /<1 yr 8%, 1-3 yr 26%, and > 3 yr 56% /. In Group A- patients with gallstones-eradication of HP infection was 63%, versus in group B –patients without gallstones 82%. P> 0.001. In patients with duration of DM >3 yr was eradication rate 47%. It was not differ between HP infection and insulin dependent or nondependet diabetic patients. For dana analysis Chi Square test, Friedman test and T-tests were used. No significant difference was found for surgical intervention and mortality into two groups. CONCLUSION: According to our results we found that HP infection was higher in group A than in Group B. The rate of infection increases with DM duration. The eradication rate was significantly lower in patients with gallstones than in group patients without gallstones. This our results could be explained by changes in microvasculature of the gastrointestinal tract and to frequent antibiotic usage for prevent recurent infection in patients with DM and gallstones especially in patients with duration of DM more than 3 yr. It was not differ between HP infection and insulin dependent or nondependet diabetic patients. Further studies are needed to clarify the possible role of HP in the development of gallstones.

Helicobacter pylori; diabetes mellitus; gallstones

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