Helicobacter pylori infection: New pathogenetic and clinical aspects

Table 1 Summary of the pathogenetic and preventive role of Helicobacter pylori

Pathogenetic role		Preventive role
Proven	Suspected	Suspected
Gastro-duodenal diseases	Gastro-intestinal diseases	Gastroesophageal diseases
Peptic ulcer	Pancreatic cancer	Gastroesophageal reflux disease
Gastric cancer	Colorectal adenoma/carcinoma	Esophageal adenocarcinoma
MALT lymphoma	Liver cirrhosis, hepatocellular carcinoma
Extra-intestinal diseases	Extra-intestinal diseases	Extra-esophageal diseases
Immune thrombocytopenic purpura	Laryngeal cancer	Bronchial asthma
Iron deficiency anemia	Lung cancer
	Metabolic syndrome/insulin resistance
	Cardiovascular diseases/ischemic heart disease
	Chronic urticaria
	Henoch-Schönlein purpura

MALT: Mucosa-associated lymphoid tissue.

Table 2 Putative pathomechanisms of Helicobacter pylori

Disease	Putative pathomechanisms
Pathogenetic role
Pancreatic cancer	Inflammatory cytokine ↑[61]
	Angiogenic factors ↑[61]
	Reactive oxygen species ↑[61]
	Somatostatin synthesis ↓[64,65]
	Secretin release ↑[64,65]
	Basal pancreatic bicarbonate output ↑[64,65]
	Bacterial overgrowth, production of N-nitroso compounds ↑[66]
	Absorption of antioxidants ↓[67]
Colorectal adenoma/ carcinoma	Direct damage[69]
	Inflammation ↑[69]
	Bacterial overgrowth, bacterial fermentation (ammonia)↑[69-71,74,75]
	NO release ↑[76]
	Hypergastrinemia[68,69]
Hepatobiliary disease	Ammonia ↑[90]
	Endotoxemia[90]
	Inflammation ↑[90]
	Hepatic fibrosis ↑[87]
	Hepatoma cell adhesion and invasion ↑[91]
Laryngeal cancer	Sensitivity to smoke and dust ↑[92]
	Cell proliferation ↑[92]
	Apoptosis ↓[92]
Lung cancer	Direct damage[97]
	Sensitivity to smoke and dust ↑[98]
	Inhalation of gastrin and urea[95]
	Hypergastrinemia[94]
	Activation of docking protein p130cas[95]
	Inflammation ↑[94]
Insulin resistance/ metabolic syndrome	Inflammation ↑[103,105]
	Vasoconstrictor factors ↑[103,105]
	Adiponectin ↓[104]
Atherogenesis	Inflammation ↑[108]
	Autoimmunity[108]
	Fibrinogen ↑[112]
	Platelet aggregation ↑[114]
Chronic urticaria	Vascular permeability ↑[83]
	Complement consumption ↑[83]
	Pathogenetic antibodies ↑[83]
Henoch-Schönlein purpura	IgA ↑[82]
	Cryoglobulins ↑[82]
	C3 ↓[82]
Possible preventive role
Gastroesophageal reflux disease	Sympathetic tone ↑[128]
	Cholinergic stimulation[128]
Esophageal adenocarcinoma	Sympathetic tone ↑[128]
	Cholinergic stimulation[128]
	Acid production ↓[129]
Bronchial asthma	Polarization of Th-1 ↓[131]
	Allergic Th-2 response ↓[131]
	Tregs ↓[132,133]
	Interleukin-1 receptor associated kinase M (IRAK-M) ↑[133]

↑: Increase; ↓: Decrease.

Table 3 Other possible pathogenetic roles of Helicobacter pylori[83,94,110,117,136,137]

Renal diseases

Renal resistive index, proteinuria

Hepatobiliary diseases

Alcoholic damages of the liver, cholestatic autoimmune liver diseases (primary biliary diseases, primary sclerosing cholangitis), cholelithiasis, cholangiocellular carcinoma

Pancreatic disorders

Autoimmune pancreatitis

Intestinal diseases

Enteric diseases, inflammatory bowel diseases

Neurological diseases

Alzheimer-disease, idiopathic parkinsonism

Dermatological diseases

Alopecia areata, atopic dermatitis, lichen planus, chronic prurigo multiformis, nodular prurigo, pruritus, psoriasis, recurrent aphthous stomatitis, rosacea, Sweet’s syndrome

Ophthalmological diseases

Glaucoma, central serous chorioretinopathy, uveitis, blepharitis

Autoimmune disorders

Autoimmune thyroiditis, Behçet’s disease, Sjögren’s syndrome, progressive systemic sclerosis

Others

Impaired bioavailability of medication such as thyroxin and l-dopa, pre-eclampsia, chronic prostatitis, growth retardation