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Clinical effects of Helicobacter pylori outside the stomach

Nature Reviews Gastroenterology & Hepatology volume 11, pages 234–242 (2014)Cite this article

Subjects

Key Points

  • Since 1994, H. pylori infection has been associated with the development of some diseases localized outside the stomach

  • H. pylori can trigger a low-grade inflammatory state and induce molecular mimicry mechanisms by expressing virulence peptides that mimic host proteins

  • H. pylori might interfere with the absorbance of different nutrients and drugs, potentially influencing the development or clinical evolution of many diseases outside the gastrointestinal tract

  • Idiopathic thrombocytopenic purpura, unexplained iron deficiency anaemia and vitamin B12 deficiency are believed to be caused by H. pylori infection

  • The association of H. pylori with some cardiovascular, hepatobiliary, pancreatic and neurodegenerative diseases as well as colorectal cancer is currently under investigation, with interesting results

Abstract

The discovery of Helicobacter pylori infection in the stomach could be considered as one of the most important events of modern gastroenterology. Understanding of the natural history of many disorders of the upper gastrointestinal tract, including chronic gastritis, peptic ulcer disease, gastric cancer and MALT lymphoma, was altered by this discovery. Interestingly, epidemiological studies have also revealed a correlation between H. pylori infection and some diseases localized outside the stomach, especially those characterized by persistent and low-grade systemic inflammation. Of note, H. pylori has an important role in iron deficiency anaemia, idiopathic thrombocytopenic purpura and vitamin B12 deficiency. Moreover, the association of this bacterial pathogen with many other diseases, including hepatobiliary, pancreatic, cardiovascular and neurodegenerative disorders is currently under investigation. In this Review, we summarize the results of the most important studies performed to date surrounding the association of H. pylori infection with extragastric diseases, as well as the strength of the evidence. We also provide information concerning bacterial–host interactions and the mechanisms implicated in the pathogenesis of each of these extragastric diseases.

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Figure 1: Pathogenic hypothesis on the possible role of CagA-positive strains in ischaemic heart disease.
Figure 2

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  1. Internal Medicine Institute, Catholic University of Rome, Policlinico A. Gemelli Largo A. Gemelli, Rome, 8-00168, Italy

    Francesco Franceschi, Giuseppe Zuccalà & Davide Roccarina

  2. Internal Medicine and Gastroenterology, Catholic University of Rome, Policlinico A. Gemelli Largo A. Gemelli, Rome, 8-00168, Italy

    Antonio Gasbarrini

Authors
  1. Francesco Franceschi
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  2. Giuseppe Zuccalà
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  3. Davide Roccarina
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  4. Antonio Gasbarrini
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Contributions

D. Roccarina and G. Zuccalà researched the data for the article. F. Franceschi wrote the article. A. Gasbarrini reviewed and edited it. All authors discussed the content of the article before submission.

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Correspondence to Francesco Franceschi.

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The authors declare no competing financial interests.

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Franceschi, F., Zuccalà, G., Roccarina, D. et al. Clinical effects of Helicobacter pylori outside the stomach. Nat Rev Gastroenterol Hepatol 11, 234–242 (2014). https://doi.org/10.1038/nrgastro.2013.243

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