Clinical Science| Volume 62, ISSUE 1, P121-126, January 2013

Download started.


Helicobacter pylori infection in patients with nonalcoholic fatty liver disease



      Clinical data regarding Helicobacter pylori (Hp) infection in nonalcoholic fatty liver disease (NAFLD) are limited. The aim was the evaluation of Hp infection in patients with NAFLD and its association with disease severity.


      28 patients with biopsy-proven NAFLD (15 with simple nonalcoholic fatty liver [NAFL], 13 with nonalcoholic steatohepatitis [NASH]) and 25 matched healthy controls were recruited. Blood samples for anti-Hp Immunoglobulin G (IgG) and standard biochemical tests were obtained after overnight fasting, and 13C urea breath test was performed before liver biopsy in NAFLD group.


      Higher rates of anti-Hp IgG (P=.038) were observed in NAFLD compared to control group. Only two NAFLD patients neither were Hp IgG seropositive nor did they have a history of eradication treatment compared to 11 control subjects (P=.002). Both Hp infection (assessed by history of Hp eradication treatment and/or Hp IgG seropositivity) (P=.034) and log(HOMA-IR) (P=.007) could independently predict NAFLD in logistic regression analysis. There were similar rates of Hp IgG seropositivity or positivity in 13C urea breath test or their combination between NAFL and NASH patients. There were no significant differences in steatosis grade, fibrosis stage, lobular or portal inflammation, or ballooning, when NAFLD patients were divided according to Hp IgG seropositivity or 13C urea breath test positivity.


      Hp infection may represent one more hit contributing to the pathogenesis of NAFL, though not to the progression from NAFL to NASH. These results warrant further validation. If confirmed, eradicating Hp infection may have certain therapeutic perspectives in NAFLD treatment.



      ALT (alanine transaminase), AST (aspartate transaminase), BMI (body mass index), CV (coefficient of variation), GGT (gamma-glutamyl transferase), HMW (high molecular weight), HOMA-IR (homeostatic model of assessment - insulin resistance), Hp (Helicobacter pylori), hsCRP (high sensitivity C-reactive protein), IgG (immunoglobulin G), IR (insulin resistance), LDL-C (low-density lipoprotein cholesterol), NAFL (simple nonalcoholic fatty liver), NAFLD (nonalcoholic fatty liver disease), NAS (NAFLD Activity Score), NASH (nonalcoholic steatohepatitis), T2DM (type 2 diabetes mellitus), TNF (tumor necrosis factor)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Metabolism - Clinical and Experimental
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Chen S.H.
        • He F.
        • Zhou H.L.
        • et al.
        Relationship between nonalcoholic fatty liver disease and metabolic syndrome.
        J Dig Dis. 2011; 12: 125-130
        • Polyzos S.A.
        • Kountouras J.
        • Zavos C.
        Nonalcoholic fatty liver disease: the pathogenetic roles of insulin resistance and adipocytokines.
        Curr Mol Med. 2009; 72: 299-314
        • Polyzos S.A.
        • Kountouras J.
        • Deretzi G.
        • et al.
        The emerging role of endocrine disruptors in pathogenesis of insulin resistance: a concept implicating nonalcoholic fatty liver disease.
        Curr Mol Med. 2012; 12: 68-82
        • Polyzos S.A.
        • Kountouras J.
        • Zavos C.
        • et al.
        The association between Helicobacter pylori infection and insulin resistance: a systematic review.
        Helicobacter. 2011; 16: 79-88
        • Figura N.
        • Franceschi F.
        • Santucci A.
        • et al.
        Extragastric manifestations of Helicobacter pylori infection.
        Helicobacter. 2010; 15: 60-68
        • Suzuki H.
        • Franceschi F.
        • Nishizawa T.
        • et al.
        Extragastric manifestations of Helicobacter pylori infection.
        Helicobacter. 2011; 16: 65-69
        • Pellicano R.
        • Menard A.
        • Rizzetto M.
        • et al.
        Helicobacter species and liver diseases: association or causation?.
        Lancet Infect Dis. 2008; 8: 254-260
        • Cindoruk M.
        • Cirak M.Y.
        • Unal S.
        • et al.
        Identification of Helicobacter species by 16S rDNA PCR and sequence analysis in human liver samples from patients with various etiologies of benign liver diseases.
        Eur J Gastroenterol Hepatol. 2008; 20: 33-36
        • Pirouz T.
        • Zounubi L.
        • Keivani H.
        • et al.
        Detection of Helicobacter pylori in paraffin-embedded specimens from patients with chronic liver diseases, using the amplification method.
        Dig Dis Sci. 2009; 54: 1456-1459
        • Takuma Y.
        Helicobacter pylori infection and liver diseases.
        Gan To Kagaku Ryoho. 2011; 38: 362-364
        • Matthews D.R.
        • Hosker J.P.
        • Rudenski A.S.
        • et al.
        Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.
        Diabetologia. 1985; 28: 412-419
        • Kleiner D.E.
        • Brunt E.M.
        • Van N.M.
        • et al.
        Design and validation of a histological scoring system for nonalcoholic fatty liver disease.
        Hepatology. 2005; 41: 1313-1321
        • Abenavoli L.
        Adiponectin levels in nonalcoholic fatty liver disease.
        Metabolism. 2011; 60: e3
        • Polyzos S.A.
        • Toulis K.A.
        • Goulis D.G.
        • et al.
        Serum total adiponectin in nonalcoholic fatty liver disease: a systematic review and meta-analysis.
        Metabolism. 2011; 60: 313-326
        • Apostolopoulos P.
        • Vafiadis-Zouboulis I.
        • Tzivras M.
        • et al.
        Helicobacter pylori (H pylori) infection in Greece: the changing prevalence during a ten-year period and its antigenic profile.
        BMC Gastroenterol. 2002; 2: 11
        • Vernon G.
        • Baranova A.
        • Younossi Z.M.
        Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults.
        Aliment Pharmacol Ther. 2011; 34: 274-285
        • Zois C.D.
        • Baltayiannis G.H.
        • Bekiari A.
        • et al.
        Steatosis and steatohepatitis in postmortem material from Northwestern Greece.
        World J Gastroenterol. 2010; 16: 3944-3949