Effect of Helicobacter pylori-eradication therapy on hepatic steatosis in patients with non-alcoholic fatty liver disease: a randomized-controlled pilot study

Vikas Maharshi; Pooja Gupta; Vijay L Kumar; Ashish Datt Upadhyay; Prasenjit Das; Rajni Yadav; Baibaswata Nayak; Ramesh Kumar; Shalimar

doi:10.1093/gastro/goz058

Effect of Helicobacter pylori-eradication therapy on hepatic steatosis in patients with non-alcoholic fatty liver disease: a randomized-controlled pilot study

Gastroenterol Rep (Oxf). 2019 Nov 25;8(2):104-110. doi: 10.1093/gastro/goz058. eCollection 2020 Apr.

Authors

Vikas Maharshi¹, Pooja Gupta¹, Vijay L Kumar¹, Ashish Datt Upadhyay², Prasenjit Das³, Rajni Yadav³, Baibaswata Nayak⁴, Ramesh Kumar⁴, Shalimar⁴

Affiliations

¹ Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India.
² Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
³ Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
⁴ Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Background: Helicobacter pylori infection has been associated with insulin resistance and non-alcoholic fatty liver disease (NAFLD). This study was done to evaluate the effect of H. pylori-eradication therapy (HPET) in patients with NAFLD compared to standard management therapy (SMT).

Methods: Eighty NAFLD patients with H. pylori co-infection were randomized into SMT (diet and exercise, n = 36) and HPET (SMT plus amoxicillin, clarithromycin, and pantoprazole, n = 44) groups. The controlled attenuation parameter (CAP), anthropometric parameters, liver enzymes, lipid profile, and glycemic parameters including homeostasis model assessment-insulin resistance (HOMA-IR) were measured and compared between two groups at the baseline and 24 weeks.

Results: Sixty-four participants (SMT group [n = 28] and HPET group [n = 36]) were included in a modified intention-to-treat analysis. Both the SMT group and the HPET group had a significant reduction in CAP scores at 24 weeks (P = 0.002 and P < 0.001, respectively), but the change between the groups was insignificant (P = 0.213). Successful eradication of H. pylori occurred in 68% of the HPET group and led to greater improvement in HOMA-IR at 24 weeks compared to SMT or non-responder patients (P = 0.007). The liver enzymes reduced significantly at 24 weeks in both groups, but the changes between the groups were similar. The lipid parameters remained unchanged within the groups and between the groups at 24 weeks. A significant increase in the levels of reduced glutathione was noted in the HPET group, but the change between the two groups was not statistically different.

Conclusions: HPET was found to be comparable to SMT alone in reducing hepatic steatosis and liver enzymes at 24 weeks in NAFLD patients. However, successful eradication of H. pylori led to greater improvement in HOMA-IR (Trial registration CTRI/2017/05/008608).

Keywords: H. pylori infection; H. pylori-eradication therapy; controlled attenuation parameter; insulin resistance; non-alcoholic fatty liver disease.