Oral Presentation of Dr. Christos Zavos (http://peptiko.gr) at the XXVIIIth International Workshop on Helicobacter and Microbiota in Inflammation and Cancer, Nicosia, Cyprus, 24-26 September 2015

1. A potential role of Helicobacter pylori
infection in nonalcoholic fatty liver disease
S. A. Polyzos, D. Chatzopoulos, J. Moschos,
A. Papatheodorou, K. Patsiaoura, E. Katsiki, E. Zafeiriadou,
C. Zavos, K. Anastasiadou, E. Terpos, J. Kountouras

2. • Hp infection and chronic liver diseases are strongly linked
• Hp-like DNA is more commonly found in liver samples from
chronic liver disease patients than from controls
Helicobacter pylori (Hp) and liver
Leone N, et al. Cancer Detect Prev 2003;27:494-7
Polyzos SA, et al. Metabolism 2013;62:121-6
Pirouz T, et al. Dig Dis Sci 2009;54:1456-9

3. • Affects 25-30% of the population in western countries
• NAFLD sequence:
• Fatty liver
• Non-alcoholic steatohepatitis (NASH)
• Liver fibrosis
• Cirrhosis - HCC
Non-alcoholic fatty liver disease (NAFLD)

4. • Limited clinical data
• Recent Japanese study evaluated Hp infection in patients with
NAFLD and its association with disease severity
• 130 NAFLD patients (biopsy proven)
• 43 with NAFL
• 87 with NASH
• Glucose tolerance
• Liver biopsies were scored for:
• NAFLD activity score (NAS)
• Fibrosis
• Iron deposits
Hp and NAFLD
Sumida Y, et al. J Gastroenterol 2015 Jan 28.

5. Results
• Hp IgG seropositivity: 40%
• The prevalence of NASH: significantly higher in patients with Hp IgG
seropositivity (81%) than in those without (58%, p = 0.008)
• Glucose intolerance was similar between the two groups
• The total NAS and the grade of hepatocyte ballooning were higher
in patients with Hp IgG seropositivity
• Hepatic iron grade was lower in patients with Hp IgG seropositivity
Sumida Y, et al. J Gastroenterol 2015 Jan 28.

6. Univariate and multivariate analyses to identify
independent variables associated with NASH
NAFIC score: NASH, Ferritin, Insulin, type IV Collagen 7 s
(used in Japan to differentiate NASH from NAFL)

7. • The association of Hp seropositivity with hepatocyte ballooning
suggests that Hp infection may represent another contributing
factor in the progression from NAFL to NASH
Thus…
Sumida Y, et al. J Gastroenterol 2015 Jan 28.

9. • To evaluate
• Hp infection in patients with NAFLD
• its association with disease severity
Aim of OUR study

10. • 28 patients with biopsy proven NAFLD
• 15 with NAFL
• 13 with NASH
• 25 matched healthy controls
• Blood samples for anti-Hp IgG and standard biochemical tests were
obtained after overnight fasting
• 13
C urea breath test was performed before liver biopsy in NAFLD
group
Patients and methods

11. Results
Comparative data of study groups

12. Hp-related data in control and NAFLD groups

13. • Hp infection (assessed by history of Hp eradication treatment
and/or Hp IgG seropositivity) (p=0.034)
and
• log(HOMA-IR) (p=0.007)
could independently predict NAFLD
Logistic regression analysis

14. Hp-related data in NAFL and NASH subgroups

15. There were no significant differences in:
• steatosis grade
• fibrosis
• lobular or portal inflammation, or ballooning
when NAFLD patients were divided according to Hp IgG
seropositivity or 13
C urea breath test positivity
Results

16. • NAFLD vs. non-NAFLD individuals had:
• higher anti-Hp IgG titers
• lower circulating adiponectin
• higher TNF-α levels
which all contribute to NAFLD pathogenesis
• Therefore, Hp infection may represent one more hit contributing to
the pathogenesis of NAFLD, though not to the progression from
NAFL to NASH
Discussion - Conclusions

17. • NAFLD, closely related to IR
• Our systematic review:
• Hp infection and IR are associated and involved in the
pathophysiology of MetS-related with NAFLD
Discussion - Conclusions
Polyzos SA, Kountouras J, Zavos C, Deretzi G. Metabolism 2013;62:121-6
Kountouras J, Polyzos SA, Zavos C, et al. Hepatology 2014,60:1450-1

18. • Although Hp eradication had no long-term effect on hepatic steatosis,
a trend towards improvement was observed in:
• NAFLD fibrosis score and
• HSENSI
• Homocysteine <12.5 μmol/L
• Serum glutamic oxaloacetic transaminase ≥37 U/L
• Erythrocyte sedimentation rate ≥20 mm
• Nonalcoholic Steatohepatitis Index
thereby warranting further relative investigation with larger studies using
paired biopsies
Discussion - Conclusions
Polyzos SA, et al. Arq Gastroenterol 2014;51:261-8

19. •These results warrant further validation
•If confirmed, eradicating Hp infection may have relative
therapeutic perspectives in NAFLD treatment
Taken together…

20. 21ST
CONGRESS OF
HELICOBACTER PYLORI AND
OTHER BACTERIAL INFECTIONS OF
GI TRACT
Athens, March 2016