Background and Aim:Helicobacter pylori infection is a primary cause of gastroduodenal ulcers. To investigate whether there is an association between H. pylori infection and small intestinal mucosal injury. Methods: Patients were selected from a general pool of subjects who underwent capsule endoscopy for current or past obscure gastrointestinal bleeding. Characteristics including age, gender, history, treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and/or acid suppressant, diagnosis, and H. pylori infection were investigated. Patients infected with H. pylori had positive test result, ranging 30 days before to 30 days after capsule endoscopy. Patients diagnosed with inflammatory diseases, malignant tumors, etc. were excluded. All video images were re-evaluated to count small intestinal mucosal breaks. Eligible patient variables were compared. Results: A total of 92 patients (30 infected with H. pylori/62 uninfected) were eligible. By univariate analysis of the number of mucosal breaks, patients treated with NSAIDs were found to have more mucosal breaks than patients untreated (38%: 8/21 vs. 18%: 13/71; p = 0.004), and the possible association was detected between patients infected with H. pylori and those who were not (67%: 14/21 vs. 37%: 26/71; p = 0.081). When comparing the H. pylori infected and uninfected patients, the rate of patients with mucosal breaks was greater in infected patients (47%: 14/30 vs. 11%: 7/62; p = 0.001). After excluding patients treated with NSAIDs, the number of mucosal breaks was also greater in patients infected with H. pylori (1.2 ± 1.5 vs. 0.38 ± 0.62; p = 0.001). Conclusion: There is a possibility that H. pylori infection induces small intestinal mucosal injury.

Journal Section:
Original Paper
Keywords:
Helicobacter pylori, Small intestinal injury, Enteropathy, Capsule endoscopy
1.
Asaka M, Kato M, Takahashi S, Fukuda Y, Sugiyama T, Ota H, et al: Guidelines for the management of Helicobacter pylori infection in Japan: 2009 revised edition. Helicobacter 2010; 15: 1–20.
2.
McColl KE: Helicobacter pylori-negative nonsteroidal anti-inflammatory drug-negative ulcer. Gastroenterol Clin North Am 2009; 38: 353–361.
3.
Gisbert JP, Calvet X. Review article: Helicobacter pylori-negative duodenal ulcer disease. Aliment Pharmacol Ther 2009; 30: 791–815.
4.
Musumba C, Pritchard DM, Pirmohamed M: Review article: cellular and molecular mechanisms of NSAID-induced peptic ulcers. Aliment Pharmacol Ther 2009; 30: 517–531.
5.
Fujimori S, Gudis K, Takahashi Y, Seo T, Yamada Y, Ehara A, et al: Distribution of small intestinal mucosal injuries as a result of NSAID administration. Eur J Clin Invest 2010; 40: 504–510.
6.
Fujimori S, Takahashi Y, Seo T, Gudis K, Ehara A, Kobayashi T, et al: Prevention of traditional NSAID-induced small intestinal injury: recent preliminary studies using capsule endoscopy. Digestion 2010; 82: 167–172.
7.
Bjarnason I, Scarpignato C, Holmgren E, Olszewski M, Rainsford KD, Lanas A: Mechanisms of damage to the gastrointestinal tract from nonsteroidal anti-inflammatory drugs. Gastroenterology 2018; 154: 500–514.
8.
Somasundaram S, Sigthorsson G, Simpson RJ, Watts J, Jacob M, Tavares IA, et al: Uncoupling of intestinal mitochondrial oxidative phosphorylation and inhibition of ­cyclooxygenase are required for the development of NSAID-enteropathy in the rat. Aliment Pharmacol Ther 2000; 14: 639–650.
9.
Nagasawa S, Azuma T, Motani H, Sato Y, Hayakawa M, Yajima D, et al. Detection of Helicobacter pylori (H. pylori) DNA in digestive systems from cadavers by real-time PCR. Leg Med (Tokyo) 2009; 11 (Suppl 1):S458–S459.
10.
Le’Negrate G, Ricci V, Hofman V, Mograbi B, Hofman P, Rossi B: Epithelial intestinal cell apoptosis induced by Helicobacter pylori depends on expression of the cag pathogenicity island phenotype. Infect Immun 2001; 69: 5001–5009.
11.
Nagai S, Mimuro H, Yamada T, Baba Y, Moro K, Nochi T, et al: Role of Peyer’s patches in the induction of Helicobacter pylori-induced gastritis. Proc Natl Acad Sci U S A 2007; 104: 8971–8976.
12.
Watanabe N, Kiriya K, Chiba T: Small intestine Peyer’s patches are major induction sites of the Helicobacter-induced host immune responses. Gastroenterology 2008; 134: 642–643.
13.
Wallace JL, Syer S, Denou E, de Palma G, Vong L, McKnight W, et al: Proton pump inhibitors exacerbate NSAID-induced small intestinal injury by inducing dysbiosis. Gastroenterology 2011; 141: 1314–1322.
14.
Fujimori S, Takahashi Y, Tatsuguchi A, Sakamoto C: Omeprazole increased small intestinal mucosal injury in two of six disease-free cases evaluated by capsule endoscopy. Dig Endosc 2014; 26: 676–679.
15.
Lo WK, Chan WW: Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth: a meta-analysis. Clin Gastroenterol Hepatol 2013; 11: 483–90.
16.
Su T, Lai S, Lee A, He X, Chen S: Meta-analysis: proton pump inhibitors moderately increase the risk of small intestinal bacterial overgrowth. J Gastroenterol 2018; 53: 27–36.
17.
Fujimori S: What are the effects of proton pump inhibitors on the small intestine? World J Gastroenterol 2015; 21: 6817–6819.
18.
Wang YH, Huang Y: Effect of lactobacillus acidophilus and bfidobacterium bifidum supplementation to standard triple therapy on Helicobacter pylori eradication and dynamic changes in intestinal flora. World J Microbiol Biotechnol 2014; 30: 847–853.
19.
Kojima Y, Takeuchi T, Sanomura M, Higashino K, Kojima K, Fukumoto K, et al: Does the novel potassium-competitive acid blocker vonoprazan cause more hypergastrinemia than conventional proton pump inhibitors? A multicenter prospective cross-sectional study. Digestion 2018; 97: 70–75.
20.
Naito Y, Kashiwagi K, Takagi T, Andoh A, Inoue R: Intestinal dysbiosis secondary to proton-pump inhibitor use. Digestion 2018; 97: 195–204.
© 2018 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2018
You do not currently have access to this content.