Randomized Clinical Trial
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2018; 6(13): 641-649
Published online Nov 6, 2018. doi: 10.12998/wjcc.v6.i13.641
Helicobacter pylori may be an initiating factor in newly diagnosed ulcerative colitis patients: A pilot study
Loai Mansour, Ferial El-Kalla, Abdelrahman Kobtan, Sherief Abd-Elsalam, Mohamed Yousef, Samah Soliman, Lobna Abo Ali, Walaa Elkhalawany, Ibrahim Amer, Heba Harras, Maha M Hagras, Mohamed Elhendawy
Loai Mansour, Ferial El-Kalla, Abdelrahman Kobtan, Sherief Abd-Elsalam, Mohamed Yousef, Samah Soliman, Lobna Abo Ali, Walaa Elkhalawany, Mohamed Elhendawy, Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta 35127, Egypt
Ibrahim Amer, Hepatology and Gastroenterology Department, Faculty of Medicine, Kafr El-Sheikh University, Kafr El-Sheikh 33511, Egypt
Heba Harras, Pathology Department, Faculty of Medicine, Tanta University, Tanta 35127, Egypt
Maha M Hagras, Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta 35127, Egypt
Author contributions: Mansour L, El-Kalla F, Kobtan A and Abd-Elsalam S designed the study; Ali LA, Elkhalawany W, Amer I and Harras H developed the methodology; El-Kalla F, Kobtan A, Abd-Elsalam S and Elhendawy M wrote the manuscript; Mansour L, El-Kalla F, Kobtan A, Abd-Elsalam S, Yousef M, Soliman S, Ali LA, Elkhalawany W, Amer I, Harras H, Hagras MM and Elhendawy M collected the data; Ali LA performed the analysis; all the authors participated sufficiently in the work and approved the final version of the manuscript.
Institutional review board statement: The study was approved in 2015 by the Ethics Committee of the Faculty of Medicine, Tanta University (code approval number: 30640/12/15).
Clinical trial registration statement: The study was registered on clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT02423395).
Informed consent statement: A written informed consent was signed by every patient before enrollment in the study.
Conflict-of-interest statement: The authors declare that they do not have any conflict of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
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: Sherief Abd-Elsalam, MD, PhD, Associate Professor, Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, El-Geish Street, Tanta 35127, Egypt. sherif_tropical@yahoo.com
Telephone: +20-10-95159522
Received: July 19, 2018
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

To directly visualize H. pylori by the highly sensitive and specific technique of immunohistochemical staining in colonic tissue from patients newly diagnosed with UC.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.