Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2015; 21(1): 240-245
Published online Jan 7, 2015. doi: 10.3748/wjg.v21.i1.240
Helicobacter pylori infection in patients with selective immunoglobulin E deficiency
Eli Magen, Menachem Schlesinger, Itzhak Ben-Zion, Daniel Vardy
Eli Magen, Menachem Schlesinger, Itzhak Ben-Zion, Daniel Vardy, Leumit Health Services, Ashdod 77456, Israel
Eli Magen, Allergy and Clinical Immunology Unit, Barzilai University Medical Center, Ashkelon 78278, Israel
Daniel Vardy, Ben-Gurion University of Negev, Beer-Sheva 8410501, Israel
Author contributions: Magen E designed the research and wrote the paper; Magen E and Vardy D performed the research; Magen E, Schlesinger M and Ben-Zion I analyzed the data.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Eli Magen, MD, Allergy and Clinical Immunology Unit, Barzilai University Medical Center, 2 Hahistadrout St, Ashkelon 78278, Israel. allergologycom@gmail.com
Telephone: +972-8-6745710 Fax: +972-8-6745712
Received: April 20, 2014
Peer-review started: April 20, 2014
First decision: May 13, 2014
Revised: June 10, 2014
Accepted: July 11, 2014
Article in press: July 11, 2014
Published online: January 7, 2015
Processing time: 262 Days and 6.9 Hours
Abstract

AIM: To investigate the prevalence and clinical characteristics of Helicobacter pylori (H. pylori)-infected dyspeptic patients with selective immunoglobulin E deficiency (IgEd).

METHODS: All individuals who underwent serum total immunoglobulin E (IgE) measurement at the Leumit Healthcare Services (Israel) in 2012 were identified in an electronic database search (n = 18487). From these, selected case group subjects were ≥ 12 years of age and had serum total IgE < 2 kIU/L (n = 158). The control group was selected from a random sampling of the remaining subjects ≥ 12 years of age to obtain a case-control ratio of 1:20 (n = 3160). Dyspeptic diseases, diagnosed no more than 5 years before serum total IgE testing, were identified and retrieved from the electronic database using specific International Classification of Diseases diagnostic codes. Results of C13-urea breath tests were used to identify subjects infected with H. pylori. Categorical variables between case and control subjects were analyzed using Fisher’s exact tests, whereas continuous variables were analyzed using χ2 tests.

RESULTS: Dyspepsia was present in 27.2% (43/158) of case subjects and 22.7% (718/3160) of controls. Of these, significantly more case subjects (32/43, 74.4%) than controls (223/718, 31.1%) were positive for H. pylori (P < 0.01). Esophagogastroduodenoscopy was performed in 19 case and 94 control subjects, revealing that gastritis was more prevalent in IgEd case subjects than in controls (57.9% vs 29.8%, P < 0.05). Furthermore, a significantly greater proportion of case subjects presented with peptic duodenal ulcers (63.2% vs 15.9%, P < 0.01). Histopathologic examination showed marked chronic inflammation, lymphoid follicle formation and prominent germinal centers, with polymorphonuclear cell infiltration of gastric glands, that was similar in case and control biopsy tissues. Finally, IgEd case subjects that underwent esophagogastroduodenoscopy were more likely to exhibit treatment-refractory H. pylori infections that require second-line triple antibiotic therapy (47.4% vs 11.7%, P < 0.01).

CONCLUSION: IgEd is associated with higher rates of H. pylori-associated gastritis and peptic duodenal ulcers.

Keywords: Selective IgE deficiency; Helicobacter pylori; Dyspeptic syndrome; Peptic ulcer disease; Inflammatory disease

Core tip: A deficiency in levels of immunoglobulin E (IgEd) has been associated with chronic inflammatory diseases, immune dysregulation, oncologic diseases, and chronic infections. This retrospective case-control study evaluated the clinical characteristics of Helicobacter pylori (H. pylori)-related dyspeptic syndrome in patients with IgEd. Analyses revealed a higher prevalence of H. pylori infection in dyspeptic patients with IgEd. Furthermore, gastritis and peptic ulcer disease were more prevalent in subjects with IgEd compared with gender- and age-matched H. pylori-infected dyspeptic patients with normal or high serum IgE levels. Finally, patients with IgEd were more likely to present treatment-refractory H. pylori infections.