Advanced Biomedical Research

The effect of Helicobacter pylori eradication on liver enzymes in patients referring with unexplained hypertransaminasemia

Authors

1 Department of Infectious Diseases, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Evidence has shown an association of Helicobacter pylori infection with liver dysfunction and damage. We investigated if H. pylori eradication affects liver enzymes in patients referring with unexplained hypertransaminasemia.
Materials and Methods: Patients with mild unexplained hypertransaminasemia accompanied with dyspepsia and confirmed H. pylori infection were studied. Viral, metabolic, autoimmune, and drug/toxin induced hepatitis as well as fatty liver were all ruled-out by appropriate tests. Patients received bismuth-containing quadruple-therapy for 2 weeks. Serum levels of liver enzymes (alanine transaminase (ALT) and aspartate transaminase (AST)) and successful eradication (with stool antigen test) were evaluated 4 weeks after the medication.
Results: A total number of 107 patients (55 males, mean age = 35.0 ± 8.4 years) were studied. Eradication was successful in 93 patients (86.9%). Serum levels of AST (6.3 ± 19.6 IU/L, P = 0.002) and ALT (7.8 ± 24.9 IU/L, P = 0.001) were significantly decreased after eradication. Levels of AST and ALT decreased to normal range respectively in 46.6% and 45.7% of the cases who had baseline levels above the normal range.
Conclusion: This study showed a decrease in liver enzymes after receiving eradication regimen of H. pylori, suggesting a role for H. pylori infection in at least some of patients with mild unexplained hypertransaminasemia. Further studies are warranted to find the underlying mechanisms by which H. pylori infection affects the liver and clinical importance of such effects.

Keywords

1. Brown LM. Helicobacter pylori: Epidemiology and routes of transmission. Epidemiol Rev 2000;22:283-97.  Back to cited text no. 1
[PUBMED]    
2. Suzuki H, Franceschi F, Nishizawa T, Gasbarrini A. Extragastric manifestations of Helicobacter pylori infection. Helicobacter 2011;16:65-9.  Back to cited text no. 2
    
3. Avenaud P, Marais A, Monteiro L, Le Bail B, Bioulac Sage P, Balabaud C, et al. Detection of Helicobacter species in the liver of patients with and without primary liver carcinoma. Cancer 2000;89:1431-9.  Back to cited text no. 3
    
4. Dore MP, Realdi G, Mura D, Graham DY, Sepulveda AR. Helicobacter infection in patients with HCV-related chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Dig Dis Sci 2002;47:1638-43.  Back to cited text no. 4
    
5. Verhoef C, Pot RG, de Man RA, Zondervan PE, Kuipers EJ, IJzermans JN, et al. Detection of identical Helicobacter DNA in the stomach and in the non-cirrhotic liver of patients with hepatocellular carcinoma. Eur J Gastroenterol Hepatol 2003;15:1171-4.  Back to cited text no. 5
    
6. Ito K, Nakamura M, Toda G, Negishi M, Torii A, Ohno T. Potential role of Helicobacter pylori in hepatocarcinogenesis. Int J Mol Med 2004;13:221-7.  Back to cited text no. 6
    
7. Rocha M, Avenaud P, Ménard A, Le Bail B, Balabaud C, Bioulac-Sage P, et al. Association of Helicobacter species with hepatitis C cirrhosis with or without hepatocellular carcinoma. Gut 2005;54:396-401.  Back to cited text no. 7
    
8. Bulajic M, Panic N, Stimec B, Isaksson B, Jesenofsky R, Schneider-Brachert W, et al. PCR in Helicobacter spp. diagnostic in extragastric malignancies of digestive system. Eur J Gastroenterol Hepatol 2012;24:117-25.  Back to cited text no. 8
    
9. Wadström T, Ljungh A, Willén R. Primary biliary cirrhosis and primary sclerosing cholangitis are of infectious origin! Gut 2001;49:454.  Back to cited text no. 9
    
10. Huang Y, Tian XF, Fan XG, Fu CY, Zhu C. The pathological effect of Helicobacter pylori infection on liver tissues in mice. Clin Microbiol Infect 2009;15:843-9.  Back to cited text no. 10
    
11. Goo MJ, Ki MR, Lee HR, Yang HJ, Yuan DW, Hong IH, et al. Helicobacter pylori promotes hepatic fibrosis in the animal model. Lab Invest 2009;89:1291-303.  Back to cited text no. 11
    
12. Esmat G, El-Bendary M, Zakarya S, Ela MA, Zalata K. Role of Helicobacter pylori in patients with HCV-related chronic hepatitis and cirrhosis with or without hepatocellular carcinoma: Possible association with disease progression. J Viral Hepat 2012;19:473-9.  Back to cited text no. 12
    
13. Queiroz DM, Rocha AM, Rocha GA, Cinque SM, Oliveira AG, Godoy A, et al. Association between Helicobacter pylori infection and cirrhosis in patients with chronic hepatitis C virus. Dig Dis Sci 2006;51:370-3.  Back to cited text no. 13
    
14. Graham DY, Osato MS, Olson CA, Zhang J, Figura N. Effect of H. pylori infection and CagA status on leukocyte counts and liver function tests: Extra-gastric manifestations of H. pylori infection. Helicobacter 1998;3:174-8.  Back to cited text no. 14
    
15. Massarrat S, Saberi-Firoozi M, Ebrahimi-Daryani N, Malekzadeh R. Approach to dyspepsia according to Helicobacter pylori status in Iran. Govaresh 2009;14:35-8.  Back to cited text no. 15
    
16. Barazandeh F, Moradi Gh, Malekzadeh R. Evaluation of efficacy of H. pylori eradication regimens in Iran: A systematic review. Govaresh 2012;16:215-22.  Back to cited text no. 16
    
17. Kazemi S, Tavakkoli H, Habizadeh MR, Emami MH. Diagnostic values of Helicobacter pylori diagnostic tests: Stool antigen test, urea breath test, rapid urease test, serology and histology. J Res Med Sci 2011;16:1097-104.  Back to cited text no. 17
[PUBMED]  Medknow Journal  
18. Ioannou GN, Boyko EJ, Lee SP. The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999-2002. Am J Gastroenterol 2006;101:76-82.  Back to cited text no. 18
    
19. Lazo M, Selvin E, Clark JM. Brief communication: Clinical implications of short-term variability in liver function test results. Ann Intern Med 2008;148:348-52.  Back to cited text no. 19
    
20. Vaubourdolle M, Chazouillères O, Briaud I, Legendre C, Serfaty L, Poupon R, et al. Plasma alpha-glutathione S-transferase assessed as a marker of liver damage in patients with chronic hepatitis C. Clin Chem 1995;41:1716-9.  Back to cited text no. 20
    
21. Karahalil B, Yaðar S, Ozin Y. Release of alpha-glutathione S-transferase (alpha-GST) and hepatocellular damage induced by Helicobacter pylori and eradication treatment. Curr Drug Saf 2007;2:43-6.  Back to cited text no. 21
    
22. Le Roux-Goglin E, Varon C, Spuul P, Asencio C, Mégraud F, Génot E. Helicobacter infection induces podosome assembly in primary hepatocytes in vitro. Eur J Cell Biol 2012;91:161-70.  Back to cited text no. 22
    
23. Ki MR, Goo MJ, Park JK, Hong IH, Ji AR, Han SY, et al. Helicobacter pylori accelerates hepatic fibrosis by sensitizing transforming growth factor-®1-induced inflammatory signaling. Lab Invest 2010;90:1507-16.  Back to cited text no. 23
    
24. Pellicano R, Ménard A, Rizzetto M, Mégraud F. Helicobacter species and liver diseases: Association or causation? Lancet Infect Dis 2008;8:254-60.  Back to cited text no. 24
    
25. Kerton A, Warden P. Review of successful treatment for Helicobacter species in laboratory mice. Lab Anim 2006;40:115-22.  Back to cited text no. 25
    
26. Kostomitsopoulos N, Donnelly H, Kostavasili I, Paronis E, Alexakos P, Karayannacos P. Eradication of Helicobacter bilis and H. hepaticus from infected mice by using a medicated diet. Lab Anim (NY) 2007;36:37-40.  Back to cited text no. 26
    
27. Emami MH, Hashemi M, Kouhestani S, Taheri H, Karimi S. Should we look for celiac disease among all patients with liver function test abnormalities? Int J Prev Med 2012;3:167-72.  Back to cited text no. 27
[PUBMED]  Medknow Journal  
Advanced Biomedical Research
Volume 2014, May
May 2014
Pages 1-5