Association between gallbladder diseases and Helicobacter pylori infection
Background: Helicobacter pylorus is one of the most harmful human pathogens & carcinogen. Of the world's population, more than 50% has H. pylori in their upper gastrointestinal tracts. It has been linked to a variety of extra gastric disorders. In correlation to hepatobiliary diseases; recently, the bacterium has been implicated as a risk factor for various diseases ranging from chronic cholecystitis and primary biliary sclerosing cholangitis to gall bladder cancer and primary hepatic carcinomas. However, the association between Helicobacter pylori (H. pylori) and gallbladder diseases is still vague and is controversial.
Aim of study: To elucidate the association of H pylori and gallbladder diseases (calculus, acalculous, polyp), the feasibility of using rapid urease test in post-operative diagnosis, and many factors related bacterium.
Subjects & methods: This case series study was conducted in Al-Kindy Teaching hospital - surgical unit during a period extended for 2 years from September 2016 to September 2018, where patients suffered from signs and symptoms of gallbladder disease were interviewed using a predesigned questionnaire including age, gender, occupation, residency and whether the drinking water was safe (purified) or not. Physical examination was done including weight status, BMI was calculated (BMI=wt. (kg)/ height (M) . Provisional diagnosis of gallbladder disease was confirmed by examination, necessary laboratory investigations (Hematology, Biochemistry, and radiology).
Cholecystectomy was done by using Laparoscopic cholecystectomy or open surgery.
The presence of H.pylori in the mucosa of excised gallbladder was studied by using:
1) Rapid urease kit (HNAN C., LTD)
2) Histopathology & chemical analysis of associated gallstone
Results: Seventy-eight patients undergoing cholecystectomy for symptomatic gallbladder disease, the gallbladder mucosa of 30 patients were tested positive for H. pylori with any one of the tests used in this study. The rapid urease test was sensitive 57.1% and specific 58.3 % of the cholecystectomies performed in our study. The mean age of studied patients was (34 ± 4 years). Females constitute 73.1% (57 out of the total 78 of patients). Of the studied cases; 26 patients (33.3%) were obese. Employee patients constitute 43 (55.1%) of patients, and 53 patients (67.9%) lived in urban areas. Purified water consumed by 61 (78.2%) of the studied population.
Gallstones were detected in 56 (71.8%) of studied cases, acalculus chronically inflamed gallbladder was found in 20 (25.64%), and 2 cases (2.56%). were found to have gallbladder polyp. pylori infection was diagnosed in 30 (38.5%) of total cases (of the 56 calculus confirmed cases 48.2% were H.pylori positive, and of the 22 acalculus cases 13.6% H.pylori positive).
Significant association is found between chronic calculus cholecystitis and H.pylori infection. While no significant association was found in correlation with acalculus cholecystitis and other gallbladder pathology. In regard to feasibility of using urease kit test, it is found that this test is sensitive 57.1%, and specific 58.3%, as such it is less accurate than histopathology study. Significant correlation was found between age, gender, weight status, and non-purified water source with H.pylori infection..