Brief Article
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World J Gastroenterol. Jul 28, 2013; 19(28): 4576-4581
Published online Jul 28, 2013. doi: 10.3748/wjg.v19.i28.4576
Helicobacter pylori and Crohn’s disease: A retrospective single-center study from China
Zun Xiang, Yi-Peng Chen, Yue-Fang Ye, Kui-Fen Ma, Shao-Hua Chen, Lin Zheng, Yi-Da Yang, Xi Jin
Zun Xiang, Yi-Peng Chen, Shao-Hua Chen, Xi Jin, Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Yue-Fang Ye, Department of Gastroenterology, the Affiliated Hospital, College of Medicine, Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
Kui-Fen Ma, Department of Pharmacy, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Lin Zheng, Yi-Da Yang, Department of Infectious Disease, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Xiang Z, Chen YP and Ye YF performed the experiments and contributed equally to the study; Ma KF, Chen SH, Zheng L and Yang YD collected the clinical data and performed the statistical analysis; Jin X designed the study and wrote the manuscript.
Supported by The National Natural Science Foundation of China, No. 81000169, 81100277 and 81200284; the Excellent Young Investigator Foundation of Health Bureau of Zhejiang Province, No. 2010QNA011; the Excellent Young Investigator Natural Science Foundation of Zhejiang Province, No. Project R2110159; Project of Zhejiang Traditional Chinese Medicine Administration Bureau, Project 2010ZA065; and the National Technology Supporting Project, No. 2008BAI52B03
Correspondence to: Xi Jin, MD, Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. jxfl007@hotmail.com
Telephone: +86-571-87236611 Fax: +86-571-87236603
Received: November 26, 2012
Revised: May 30, 2013
Accepted: June 19, 2013
Published online: July 28, 2013
Processing time: 248 Days and 4.1 Hours
Abstract

AIM: To investigate the association between Helicobacter pylori (H. pylori) infection and the prevalence of Crohn’s disease (CD).

METHODS: Subjects were selected from patients admitted the gastrointestinal (GI) department at The First Affiliated Hospital School of Medicine (Zhejiang University) for abdominal pain, hematochezia, diarrhea and other GI symptoms between January 2008 and September 2012. CD was diagnosed by endoscopy and biopsy. H. pylori infection was detected by a 14C-urea breath test and culturing of the biopsy sample. Demographic, anthropometric and serologic data were collected for each patient. H. pylori infection rate was compared between CD and control groups, followed by a subgroup analysis based on extent and severity of CD. Student’s t, Mann-Whiney U, and χ2 tests were used to analyze the data.

RESULTS: A total of 447 patients were analyzed, including 229 in the CD group and 248 in the control group. There were no significant differences in age, sex, and rates of hypertension or diabetes. However, the CD group showed significantly higher rates of smoking history (34.9% vs 18.1%), alcohol intake (17.4% vs 8.1%), white blood cell count (9.7 ± 2.9 × 109/L vs 4.3 ± 0.9 × 109/L), and C-reactive protein (36.3 ± 20.8 mg/L vs 5.5 ± 2.3 mg/L) but lower body mass index (24.5 ± 2.0 kg/m2vs 26.0 ± 2.2 kg/m2) than the control group. The H. pylori infection rate in the CD group was 27.1%, significantly lower than that of 47.9% in the control group. Furthermore, the H. pylori infection rates in patients with colonic, small intestine, ileocolonic and extensive CD were 31.1%, 28.9%, 26.8% and 25.9% respectively, all of which were significantly lower than in the control group. Finally, the H. pylori infection rates in patients with remission, moderate and severe CD were 34.3%, 30.7% and 22.0% respectively, which were also significantly lower than in the control group.

CONCLUSION: Lower H. pylori infection in CD patients suggests a correlation between bacterial infection and CD, suggesting caution when considering H. pylori eradication in CD patients.

Keywords: Crohn’s disease; Helicobacter pylori; Urea breath test; Biopsy; Pathogenesis; Inflammatory bowel disease; Bacteria

Core tip: The association between Helicobacter pylori (H. pylori) infection and Crohn’s disease (CD) prevalence is still unclear. In this retrospective study, we collected 229 CD patients and 248 control subjects to investigate the risk factors for prevalence, extent and severity of CD. Through extensive analysis, we found significantly lower H. pylori infection rates in CD patients having different disease extent and severity, providing evidence for bacteria involvement in CD pathogenesis and serving as a reminder for clinicians to remain cautious when considering H. pylori eradication in CD patients.