Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 166.39
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2017, vol. 26, nr 9, December, p. 1377–1381

doi: 10.17219/acem/65430

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

The influence of vitamin D deficiency on eradication rates of Helicobacter pylori

Oguzhan Yildirim1,A,C,D,E,F, Tulay Yildirim2,B,C,D,F, Yuksel Seckin1,B,D,E, Pelin Osanmaz3,B,C, Yilmaz Bilgic1,B,D, Rafet Mete4,A,B,D,E,F

1 Department of Gastroenterology, Faculty of Medicine, Inonu University, Malatya, Turkey

2 Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Inonu University, Malatya, Turkey

3 Department of Internal Medicine, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey

4 Department of Gastroenterology, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey


Background. Helicobacter pylori eradication therapy improves the healing of various gastro-duodenal diseases such as chronic gastritis and peptic ulcer, and also reduces gastric cancer incidence. Several studies have reported on risk factors other than antibiotic resistance related to Helicobacter pylori eradication failure.
Objectives. In this study, we aimed to investigate whether or not the serum levels of 25-hydroxy-vitamin D (25(OH)D) influence eradication rates of H.pylori.
Material and Methods. 220 patients diagnosed with H.pylori gastritis using endoscopic biopsy had their 25-OH vitamin D levels measured via the electrochemiluminescence method before beginning eradication therapy of H.pylori. Gastric biopsies obtained at endoscopy were examined for H.pylori strains and histopathologic findings. All patients were treated with bismuth-containing quadruple therapy for 14 days. H.pylori eradication was determined via the 14C-urea breath test performed 4 weeks after the end of therapy. Based on the 25-OH vitamin D levels, the patients were divided into 2 groups: group 1 (deficient) had a vitamin D level of <10 ng/mL, while group 2 (sufficient) had a vitamin D level of ≥10 ng/ mL.
Results. Eradication was successful in 170 (77.2%) patients and failed in 50 (22.7%) patients. The prevalence of 25(OH)D deficiency was 30.5%. Mean 25(OH)D levels were significantly lower in the eradication failure group compared to the successful treatment group (9.13 ±4.7 vs 19.03 ±8.13; p = 0.001). There were significantly more patients with deficient 25(OH)D levels in the failed treatment group compared to the successful treatment group (p = 0.001).
Conclusion. Our findings suggest that 25-OH vitamin D deficiency may be considered a risk factor related to eradication failure of H.pylori, which may lead to a need for supplementation of vitamin D before eradication of H.pylori.

Key words

vitamin D, Helicobacter pylori, Helicobacter pylori eradication

References (30)

  1. Dunn BE, Cohen H, Blaser MJ. Helicobacter pylori. Clin Microbiol Rev. 1997;10(4):720–724.
  2. Perez-Perez GI, Rothenbacher D, Brenner H. Epidemiology of Helicobacter pylori infection. Helicobacter. 2004;9(Suppl 1):1–6.
  3. Malfertheiner P, Link A, Selgrad M. Helicobacter pylori: Perspectives and time trends. Nat Rev Gastroenterol Hepatol. 2014;11(10):628–388.
  4. Take S, Mizuno M, Ishiki K, et al. The effect of eradicating Helicobacter pylori on the development of gastric cancer in patients with peptic ulcer disease. Am J Gastroenterol. 2005;100:1037–1042.
  5. Uotani T, Miftahussurur M, Yamaoka Y. Effect of bacterial and host factors on Helicobacter pylori eradication therapy. Expert Opin Ther Targets. 2015;19(12):1637–1650.
  6. Baeke F, Takiishi T, Korf H, Gysemans C, Mathieu C. Vitamin D: Modulator of the immune system. Curr Opin Pharmacol. 2010;10(4):482–496.
  7. Hong JY, Kim SY, Chung KS, et al. Association between vitamin D deficiency and tuberculosis in a Korean population. Int J Tuberc Lung Dis. 2014;18(1):73–78.
  8. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney system. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. 1996;20(10):1161–1181.
  9. Lips P. Vitamin D status and nutrition in Europe and Asia. J Steroid Biochem Mol Biol. 2007;103:620–625.
  10. Gatta L, Vakil N, Vaira D, Scarpignato C. Global eradication rates for Helicobacter pylori infection: Systematic review and meta-analysis of sequential therapy. BMJ. 2013;347:f4587.
  11. Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection – The Maastricht IV/ Florence Consensus Report. Gut. 2012;61:642–664.
  12. Bagheri N, Azadegan-Dehkordi F, Shirzad H, Rafieian-Kopaei M, Rahimian G, Razavi A. The biological functions of IL-17 in different clinical expressions of Helicobacter pylori-infection. Microb Pathog. 2015;81:338.
  13. van Doorn LJ, Schneeberger PM, Nouhan N, Plaisier AP, Quint WGV, de Boer WA. Importance of Helicobacter pylori CagA and VacA status for the efficacy of antibiotic treatment. Gut. 2000;46:321–326.
  14. Scholte GH, van Doorn LJ, Cats A, et al. Genotyping of Helicobacter pylori in paraffin-embedded gastric biopsy specimens: Relation to histological parameters and effects on therapy. Am J Gastroenterol. 2002;97(7):1687–1695.
  15. Maeda S, Yoshida H, Ikenoue T, et al. Structure of cag pathogenicity island in Japanese Helicobacter pylori isolates. Gut. 1999;44(3):336–341.
  16. Shah DK, Jain SS, Mohite A, Amarapurkar AD, Contractor QQ, Rathi PM. Effect of H. pylori density by histopathology on its complications and eradication therapy. Trop Gastroenterol. 2015;36(2):101–106.
  17. Onal IK, Gokcan H, Benzer E, Bilir G, Oztas E. What is the impact of Helicobacter pylori density on the success of eradication therapy: A clinico-histopathological study. Clin Res Hepatol Gastroenterol. 2013;37(6):642–646.
  18. Zambon CF, Fasolo M, Basso D, et al. Clarithromycin resistance, tumor necrosis factor alpha gene polymorphism and mucosal inflammation affect H. pylori eradication success. J Gastrointest Surg. 2007;11(11):1506–1514.
  19. Kamada T, Haruma K, Komoto K, et al. Effect of smoking and histological gastritis severity on the rate of H. pylori eradication with omeprazole, amoxicillin, and clarithromycin. Helicobacter. 1999;4(3):204–210.
  20. Borody T, Ren Z, Pang G, Clancy R. Impaired host immunity contributes to Helicobacter pylori eradication failure. Am J Gastroenterol. 2002;97:3032–3037.
  21. Clancy R, Borody T, Ren Z, Pang G. Can the response to eradication therapy in Helicobacter pylori infection be predicted? Can J Gastroenterol. 2003;17(Suppl B):58B–61B.
  22. Penna G, Roncari A, Amuchastegui S, et al. Expression of the inhibitory receptor ITL3 on dendritic cells is dispensable for induction of CD4þFoxp3þ regulatory T cells by 1,25-dihy-droxyvitamin D3. Blood. 2005;106:3490–3497.
  23. Sahay T, Ananthakrishnan AN. Vitamin D deficiency is associated with community-acquired clostridium difficile infection: A case-control study. BMC Infect Dis. 2014;14:661.
  24. Grant WB. Variations in vitamin D production could possibly explain the seasonality of childhood respiratory infections in Hawaii. Pediatr Infect Dis J. 2008;27:853.
  25. Liu PT, Stenger S, Li H, et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006;311(5768):1770–1773.
  26. Nnoaham KE, Clarke A. Low serum vitamin D levels and tuberculosis: A systematic review and meta-analysis. Int J Epidemiol. 2008;37(1):113–119.
  27. Hosoda K, Shimomura H, Wanibuchi K, et al. Identification and characterization of a vitamin D₃ decomposition product bactericidal against Helicobacter pylori. Sci Rep. 2015;5:8860.
  28. Ramanathan B, Davis EG, Ross CR, Blecha F. Cathelicidins: Microbicidal activity, mechanisms of action, and roles in innate immunity. Microbes Infect. 2002;4:361–372.
  29. Wang TT, Nestel FP, Bourdeau V, et al. Cutting edge: 1,25-dihydroxyvitamin D3 is a direct inducer of antimicrobial peptide gene expression. J Immunol. 2004;173(5):2909–2912.
  30. Wehkamp J, Schauber J, Stange EF. Defensins and cathelicidins in gastrointestinal infections. Curr Opin Gastroenterol. 2007;23:32–38.