Published online Nov 6, 2018. doi: 10.12998/wjcc.v6.i13.641
Peer-review started: July 19, 2018
First decision: July 31, 2018
Revised: September 3, 2018
Accepted: October 23, 2018
Article in press: October 23, 2018
Published online: November 6, 2018
Processing time: 110 Days and 12.4 Hours
Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) of the colon with an unidentified cause. Genetic and environmental elements, in particular the gut bacteria appear to play a role in its development. It has been hypothesized that Helicobacter pylori (H. pylori) infection may play a role in IBD pathogenesis due to their comparable immunological features.
The association between H. pylori and UC is subject to much dispute. The impact of bacteria on development of colonic inflammation is supported by the fact that germ free mice show no signs of bowel inflammation, also among patients with IBD a favorable response may be seen to antibiotic treatment and faecal diversion.
To directly visualize H. pylori by the highly sensitive and specific technique of immunohistochemical staining in colonic tissue from patients newly diagnosed with UC.
Colonoscopic biopsies from thirty patients with newly diagnosed UC and thirty controls were stained with Giemsa stain and immunohistochemical stain for detection of H. pylori in the colonic tissue. Results were confirmed by testing H. pylori Ag in the stool then infected patients were randomized to receive either anti H. pylori treatment or placebo.
Twelve/30 (40%) of the UC patients were positive for H. pylori by Giemsa, and 17/30 (56.6%) by immunohistochemistry stain. Among the control group 4/30 (13.3%) and 6/30 (20%) were positive for H. pylori by Giemsa and immunohistochemistry staining respectively. H. pylori was significantly higher in UC than in controls (P = 0.04 and 0.007). All Giemsa positive patients and controls were positive by immunohistochemical stain. Four cases of the control group positive for H. pylori also showed microscopic features consistent with early UC.
H. pylori can be detected in colonic mucosa of patients with UC and patients with histological superficial ulcerations and mild infiltration consistent with early UC. There seems to be an association between UC and presence of H. pylori in the colonic tissue. Whether this is a causal relationship or not remains to be discovered.
There seems to be an association between UC and presence of H. pylori in the colonic tissue. Whether this is a causal relationship or not remains to be discovered.