Research letterCarbohydrate metabolism improvement after Helicobacter pylori eradication
Introduction
Several studies have found controversial relationships between Helicobacter pylori (H.pylori) infection and components of the metabolic syndrome (MetS) and hormones involved in energy homoeostasis, such as ghrelin and glucagon-like peptide-1 (GLP-1). H. pylori colonization and eradication have been linked to gastric ghrelin production. Nweneka et al. [1] concluded that plasma ghrelin levels were significantly lower in H. pylori-infected subjects vs uninfected subjects, with no significant effect of circulating ghrelin on H. pylori eradication. Discrepancies between studies may be due to differences in the populations studied, disease complications (with or without gastric atrophy), type of H. pylori strain, type of immunoassay and duration of the study period, and also because ghrelin is not only produced in the stomach. Other authors have described relationships between H. pylori infection, ghrelin and weight [2].
The aim of the present study was to assess, for the first time to our knowledge, changes in incretins and carbohydrate metabolism with an oral glucose tolerance test (OGTT) before and after antibiotic eradication treatment of patients colonized by H. pylori.
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Material and methods
The present prospective case study was conducted in 32 non-diabetic patients infected by H. pylori. The sample size was calculated based on the average levels of ghrelin before and after eradication therapy in H. pylori-positive patients [3]. A minimum sample size of 15 subjects was the result of a t test for paired samples of the FIRST programme [α error: 0.05, mean difference: 10.63, standard deviation (SD): 10.23, 95% statistical power].
Our 32 patients, who were all positive for H. pylori
Results
Thirty-two patients were studied. Their average age was 49 ± 2.03 years; 75% were women and 46.9% had a personal history of gastrointestinal disease (15.6% gastroesophageal reflux, 12.5% peptic ulcer, 3.1% irritable bowel). Of these patients, 81.3% (n = 26) achieved eradication of H. pylori. Clinical and analytical variables are summarized in Table 1. Significant correlations were found between HbA1c and levels of GLP-1 post-treatment at all time points after OGTT (Fig. 1). Levels of ghrelin
Discussion
Our present study assessed changes in carbohydrate metabolism, and secretion of GLP-1 and ghrelin, induced by OGTT in patients before and after antibiotic eradication treatment of H. pylori. Across studies, gender distribution has been highly heterogeneous, although some were similar to ours [4], [5]. Body weight gain after H. pylori eradication has also been described. Several authors have suggested that plasma ghrelin concentration is strongly influenced by body weight changes [2], [6], such
Disclosure of interest
The authors declare that they have no competing interest.
Acknowledgements
Editorial assistance was provided by Maria Repice.
Funding: Araceli Muñoz Garach is supported by a fellowship (Rio Hortega CM14/00078) from the Instituto de Salud Carlos III (Carlos III Institute of Health), Spanish Ministry of Economy and Competitiveness.
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M.M.R.R. and L.C.A. contributed equally to this manuscript.