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  • 1. Aims and Scope

    Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE

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    Yong Chan Lee Professor of Medicine
    Director, Gastrointestinal Research Laboratory
    Veterans Affairs Medical Center, Univ. California San Francisco
    San Francisco, USA

    Deputy Editor

    Deputy Editor
    Jong Pil Im Seoul National University College of Medicine, Seoul, Korea
    Robert S. Bresalier University of Texas M. D. Anderson Cancer Center, Houston, USA
    Steven H. Itzkowitz Mount Sinai Medical Center, NY, USA
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    All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
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Changes in Metabolic Parameters by Helicobacter pylori Eradication According to Sex Differences

Sung Eun Kim

Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea

Correspondence to: Sung Eun Kim
ORCID https://orcid.org/0000-0002-1835-4830
E-mail solefide@hanmail.net

See See “Long-term Effects of the Eradication of Helicobacter pylori on Metabolic Parameters, Depending on Sex, in South Korea” by Jaehyung Park, et al. on page 58, Vol. 17, No. 1, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gut Liver 2023;17(1):1-2. https://doi.org/10.5009/gnl220541

Published online January 15, 2023, Published date January 15, 2023

Copyright © Gut and Liver.

Helicobacter pylori is a unique bacterium that has an obvious etiological role in various gastrointestinal diseases, including gastritis, peptic ulcer, gastric mucosa-associated lymphoid-tissue lymphoma, and gastric cancer, through chronic inflammation. Researchers have investigated whether the chronic inflammation induced by H. pylori infection can lead to diseases other than those of the stomach in humans, and interest in these fields has increased. Since the mid-1990s, many studies have been published on the association between H. pylori infection and extragastric disorders, including hematologic, cardiovascular, neurodegenerative, autoimmune, allergic, dermatologic, and metabolic diseases.1

Metabolic syndrome (MS) is a cluster of metabolic abnormalities that increases the risk of developing diabetes and cardiovascular or cerebrovascular diseases.2 The diagnostic criteria for MS include hypertension, hyperglycemia, dyslipidemia, and central obesity.2 All these are essential metabolic parameters, among them, the possibility of an association between H. pylori infection and dyslipidemia has been steadily raised. This could be because MS and dyslipidemia are presumed to be caused by chronic low-grade systemic inflammation, and H. pylori has been shown to exacerbate chronic inflammation in the host. A multicenter nationwide study from Korea (n=15,195) revealed that H. pylori infection is positively related to body mass index (BMI), total cholesterol, and low-density lipoprotein (LDL) cholesterol, and negatively associated with high-density lipoprotein (HDL) cholesterol.3 A meta-analysis that included 27 studies from around the world also reported that H. pylori-positive participants had higher levels of LDL cholesterol, triglyceride, and total cholesterol and lower levels of HDL cholesterol in their blood than H. pylori-negative participants.4 However, several studies have failed to demonstrate the association between H. pylori infection and deranged metabolic parameters.5

Investigating changes in metabolic parameters after H. pylori eradication can also determine the effect of H. pylori infection on MS and dyslipidemia. In that regard, Park et al.6 reported in an issue of Gut and Liver that H. pylori eradication-related alteration in metabolic parameters varied by sex. This prospective observational study divided the participants into three groups based on their H. pylori status: H. pylori-uninfected (n=509), H. pylori-non-eradicated (n=346), and H. pylori-eradicated (n=666). Metabolic parameters were measured in each group after H. pylori eradication therapy. The follow-up period was 5 years, and sex-specific analyses were conducted. When the results were analyzed without taking sex into account, the HDL cholesterol levels and BMI, among various parameters, were found to have increased 1 year after H. pylori eradication therapy; however, no significant differences were observed at 3 and 5 years. Regarding sex-based differences, HDL cholesterol increased in females (p=0.023), and BMI increased in males (p=0.010) after the H. pylori eradication therapy. However, after propensity score matching, HDL cholesterol was found to have significantly increased in females (p=0.006), and BMI tended to increase in males (p=0.089) in the first year of follow-up.

Several studies have investigated the effect of H. pylori eradication on MS and dyslipidemia; however, the results remain controversial. A Korean prospective cohort study (n=13,383) showed that successful H. pylori eradication reduced the risk of developing high LDL cholesterol and low HDL cholesterol levels.7 In addition, a recent meta-analysis evaluating 24 studies reported that H. pylori eradication increased HDL cholesterol levels; however, triglyceride levels also increased after H. pylori eradication.8 Few studies have examined the long-term effect of H. pylori eradication on MS and dyslipidemia, and even fewer have evaluated the variations by sex. Only two of the 24 studies included in the meta-analysis had a follow-up of more than 1 year.8

Although the effect of H. pylori eradication on MS and dyslipidemia has not been investigated, a retrospective study from Korea reported that H. pylori infection is associated with increased total cholesterol in males and decreased HDL cholesterol in females.9 A recent Korean retrospective cohort study demonstrated that successful H. pylori eradication reduced the risk of developing low HDL cholesterol in females and high LDL cholesterol in males.10 The baseline BMI differed between H. pylori-persistent and H. pylori-eradicated groups, but sex-specific subgroup analysis for BMI was not performed.10

This study had several limitations. Firstly, the terms H. pylori-negative status and H. pylori-uninfected status were used interchangeably. In clinical practice, it is challenging to prove H. pylori-negativity; however, H. pylori-negative and H. pylori-uninfected can be different. Second, patients with hypertension, dyslipidemia, and type 2 diabetes mellitus, as well as patients taking medications such as lipid-lowering agents, were included, which may have affected the study results. In addition, this study showed that H. pylori eradication affected MS and metabolic parameters differently by sex, but the mechanism by which these effects occur is still unknown. Nonetheless, this study is valuable since no other study has followed up a large number of patients over 5 years to establish the association between H. pylori eradication and MS and metabolic parameters by sex. However, further well-designed prospective studies are required to determine the influence of H. pylori infection and its eradication on metabolic parameters and diseases, including MS.

No potential conflict of interest relevant to this article was reported.

  1. Pellicano R, Ianiro G, Fagoonee S, Settanni CR, Gasbarrini A. Review: extragastric diseases and Helicobacter pylori. Helicobacter 2020;25 Suppl1:e12741.
    Pubmed CrossRef
  2. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005;365:1415-1428.
    Pubmed CrossRef
  3. Lim SH, Kim N, Kwon JW, et al. Positive association between Helicobacter pylori infection and metabolic syndrome in a Korean population: a multicenter nationwide study. Dig Dis Sci 2019;64:2219-2230.
    Pubmed CrossRef
  4. Shimamoto T, Yamamichi N, Gondo K, et al. The association of Helicobacter pylori infection with serum lipid profiles: an evaluation based on a combination of meta-analysis and a propensity score-based observational approach. PLoS One 2020;15:e0234433.
    Pubmed KoreaMed CrossRef
  5. Danesh J, Youngman L, Clark S, Parish S, Peto R, Collins R. Helicobacter pylori infection and early onset myocardial infarction: case-control and sibling pairs study. BMJ 1999;319:1157-1162.
    Pubmed KoreaMed CrossRef
  6. Park J, Kim N, Kim WS, et al. Long-term effects of the eradication of Helicobacter pylori on metabolic parameters, depending on sex, in South Korea. Gut Liver 2023;17:58-68.
    Pubmed CrossRef
  7. Nam SY, Ryu KH, Park BJ, Park S. Effects of Helicobacter pylori infection and its eradication on lipid profiles and cardiovascular diseases. Helicobacter 2015;20:125-132.
    Pubmed CrossRef
  8. Watanabe J, Hamasaki M, Kotani K. The effect of Helicobacter pylori eradication on lipid levels: a meta-analysis. J Clin Med 2021;10:904.
    Pubmed KoreaMed CrossRef
  9. Seo KI, Heo JJ, Kim SE, et al. Sex differences between Helicobacter pylori infection and cholesterol levels in an adult health checkup program. Helicobacter 2020;25:e12704.
    Pubmed CrossRef
  10. Park Y, Kim TJ, Lee H, et al. Eradication of Helicobacter pylori infection decreases risk for dyslipidemia: a cohort study. Helicobacter 2021;26:e12783.
    Pubmed CrossRef

Article

Editorial

Gut and Liver 2023; 17(1): 1-2

Published online January 15, 2023 https://doi.org/10.5009/gnl220541

Copyright © Gut and Liver.

Changes in Metabolic Parameters by Helicobacter pylori Eradication According to Sex Differences

Sung Eun Kim

Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea

Correspondence to:Sung Eun Kim
ORCID https://orcid.org/0000-0002-1835-4830
E-mail solefide@hanmail.net

See See “Long-term Effects of the Eradication of Helicobacter pylori on Metabolic Parameters, Depending on Sex, in South Korea” by Jaehyung Park, et al. on page 58, Vol. 17, No. 1, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Body

Helicobacter pylori is a unique bacterium that has an obvious etiological role in various gastrointestinal diseases, including gastritis, peptic ulcer, gastric mucosa-associated lymphoid-tissue lymphoma, and gastric cancer, through chronic inflammation. Researchers have investigated whether the chronic inflammation induced by H. pylori infection can lead to diseases other than those of the stomach in humans, and interest in these fields has increased. Since the mid-1990s, many studies have been published on the association between H. pylori infection and extragastric disorders, including hematologic, cardiovascular, neurodegenerative, autoimmune, allergic, dermatologic, and metabolic diseases.1

Metabolic syndrome (MS) is a cluster of metabolic abnormalities that increases the risk of developing diabetes and cardiovascular or cerebrovascular diseases.2 The diagnostic criteria for MS include hypertension, hyperglycemia, dyslipidemia, and central obesity.2 All these are essential metabolic parameters, among them, the possibility of an association between H. pylori infection and dyslipidemia has been steadily raised. This could be because MS and dyslipidemia are presumed to be caused by chronic low-grade systemic inflammation, and H. pylori has been shown to exacerbate chronic inflammation in the host. A multicenter nationwide study from Korea (n=15,195) revealed that H. pylori infection is positively related to body mass index (BMI), total cholesterol, and low-density lipoprotein (LDL) cholesterol, and negatively associated with high-density lipoprotein (HDL) cholesterol.3 A meta-analysis that included 27 studies from around the world also reported that H. pylori-positive participants had higher levels of LDL cholesterol, triglyceride, and total cholesterol and lower levels of HDL cholesterol in their blood than H. pylori-negative participants.4 However, several studies have failed to demonstrate the association between H. pylori infection and deranged metabolic parameters.5

Investigating changes in metabolic parameters after H. pylori eradication can also determine the effect of H. pylori infection on MS and dyslipidemia. In that regard, Park et al.6 reported in an issue of Gut and Liver that H. pylori eradication-related alteration in metabolic parameters varied by sex. This prospective observational study divided the participants into three groups based on their H. pylori status: H. pylori-uninfected (n=509), H. pylori-non-eradicated (n=346), and H. pylori-eradicated (n=666). Metabolic parameters were measured in each group after H. pylori eradication therapy. The follow-up period was 5 years, and sex-specific analyses were conducted. When the results were analyzed without taking sex into account, the HDL cholesterol levels and BMI, among various parameters, were found to have increased 1 year after H. pylori eradication therapy; however, no significant differences were observed at 3 and 5 years. Regarding sex-based differences, HDL cholesterol increased in females (p=0.023), and BMI increased in males (p=0.010) after the H. pylori eradication therapy. However, after propensity score matching, HDL cholesterol was found to have significantly increased in females (p=0.006), and BMI tended to increase in males (p=0.089) in the first year of follow-up.

Several studies have investigated the effect of H. pylori eradication on MS and dyslipidemia; however, the results remain controversial. A Korean prospective cohort study (n=13,383) showed that successful H. pylori eradication reduced the risk of developing high LDL cholesterol and low HDL cholesterol levels.7 In addition, a recent meta-analysis evaluating 24 studies reported that H. pylori eradication increased HDL cholesterol levels; however, triglyceride levels also increased after H. pylori eradication.8 Few studies have examined the long-term effect of H. pylori eradication on MS and dyslipidemia, and even fewer have evaluated the variations by sex. Only two of the 24 studies included in the meta-analysis had a follow-up of more than 1 year.8

Although the effect of H. pylori eradication on MS and dyslipidemia has not been investigated, a retrospective study from Korea reported that H. pylori infection is associated with increased total cholesterol in males and decreased HDL cholesterol in females.9 A recent Korean retrospective cohort study demonstrated that successful H. pylori eradication reduced the risk of developing low HDL cholesterol in females and high LDL cholesterol in males.10 The baseline BMI differed between H. pylori-persistent and H. pylori-eradicated groups, but sex-specific subgroup analysis for BMI was not performed.10

This study had several limitations. Firstly, the terms H. pylori-negative status and H. pylori-uninfected status were used interchangeably. In clinical practice, it is challenging to prove H. pylori-negativity; however, H. pylori-negative and H. pylori-uninfected can be different. Second, patients with hypertension, dyslipidemia, and type 2 diabetes mellitus, as well as patients taking medications such as lipid-lowering agents, were included, which may have affected the study results. In addition, this study showed that H. pylori eradication affected MS and metabolic parameters differently by sex, but the mechanism by which these effects occur is still unknown. Nonetheless, this study is valuable since no other study has followed up a large number of patients over 5 years to establish the association between H. pylori eradication and MS and metabolic parameters by sex. However, further well-designed prospective studies are required to determine the influence of H. pylori infection and its eradication on metabolic parameters and diseases, including MS.

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

References

  1. Pellicano R, Ianiro G, Fagoonee S, Settanni CR, Gasbarrini A. Review: extragastric diseases and Helicobacter pylori. Helicobacter 2020;25 Suppl1:e12741.
    Pubmed CrossRef
  2. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005;365:1415-1428.
    Pubmed CrossRef
  3. Lim SH, Kim N, Kwon JW, et al. Positive association between Helicobacter pylori infection and metabolic syndrome in a Korean population: a multicenter nationwide study. Dig Dis Sci 2019;64:2219-2230.
    Pubmed CrossRef
  4. Shimamoto T, Yamamichi N, Gondo K, et al. The association of Helicobacter pylori infection with serum lipid profiles: an evaluation based on a combination of meta-analysis and a propensity score-based observational approach. PLoS One 2020;15:e0234433.
    Pubmed KoreaMed CrossRef
  5. Danesh J, Youngman L, Clark S, Parish S, Peto R, Collins R. Helicobacter pylori infection and early onset myocardial infarction: case-control and sibling pairs study. BMJ 1999;319:1157-1162.
    Pubmed KoreaMed CrossRef
  6. Park J, Kim N, Kim WS, et al. Long-term effects of the eradication of Helicobacter pylori on metabolic parameters, depending on sex, in South Korea. Gut Liver 2023;17:58-68.
    Pubmed CrossRef
  7. Nam SY, Ryu KH, Park BJ, Park S. Effects of Helicobacter pylori infection and its eradication on lipid profiles and cardiovascular diseases. Helicobacter 2015;20:125-132.
    Pubmed CrossRef
  8. Watanabe J, Hamasaki M, Kotani K. The effect of Helicobacter pylori eradication on lipid levels: a meta-analysis. J Clin Med 2021;10:904.
    Pubmed KoreaMed CrossRef
  9. Seo KI, Heo JJ, Kim SE, et al. Sex differences between Helicobacter pylori infection and cholesterol levels in an adult health checkup program. Helicobacter 2020;25:e12704.
    Pubmed CrossRef
  10. Park Y, Kim TJ, Lee H, et al. Eradication of Helicobacter pylori infection decreases risk for dyslipidemia: a cohort study. Helicobacter 2021;26:e12783.
    Pubmed CrossRef
Gut and Liver

Vol.17 No.1
January, 2023

pISSN 1976-2283
eISSN 2005-1212

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