Helicobacter EFFECT OF HELICOBACTER PYLORI ERADICATION ON HEPATIC STEATOSIS , NAFLD FIBROSIS SCORE AND HSENSI IN PATIENTS WITH NONALCOHOLIC STEATOHEPATITIS : a MR imaging-based pilot open-label study

Context Limited clinical data suggest Helicobacter pylori (Hp) infection may contribute to nonalcoholic fatty liver disease (NAFLD) pathogenesis. Objective The effect of Hp eradication on hepatic steatosis (magnetic resonance imaging), nonalcoholic fatty liver disease fibrosis score and HSENSI (Homocysteine, serum glutamic oxaloacetic transaminase, Erythrocyte sedimentation rate, nonalcoholic steatohepatitis Index) in nonalcoholic steatohepatitis patients. Methods Thirteen adult patients with biopsy-proven nonalcoholic steatohepatitis, asymptomatic for gastrointestinal disease, underwent 13C urea breath test; Hp positive patients received eradication therapy until repeat test become negative. Hepatic fat fraction, standard biochemical tests and calculation of nonalcoholic fatty liver disease fibrosis score and HSENSI were performed at baseline and month 12. Results Hepatic fat fraction was similar for between and within group comparisons. Nonalcoholic fatty liver disease fibrosis score showed a non-significant trend towards decrease in Hp(+) [-0.34 (-1.39-0.29) at baseline and -0.24 (-0.99-0.71) at month 12; P = 0.116], whereas increase in Hp(-) group [-0.38 (-1.72-0.11) and -0.56 (-1.43-0.46), respectively; P = 0.249]. HSENSI was significantly decreased only in Hp(+) group [1.0 (1.0-2.0) at baseline and 1.0 (0-1.0) at month 12; P = 0.048]. Conclusions Hp eradication had no long-term effect on hepatic steatosis, but showed a trend towards improvement in nonalcoholic fatty liver disease fibrosis score and HSENSI. These results warrant larger studies with paired biopsies. HEADINGS Helicobacter pylori. Fatty liver. Magnetic resonance imaging. Declared conflict of interest of all authors: none No source of support or funding for this study 1 Second Medical Clinic, Medical School, Aristotle University of Thessaloniki, Ippokration Hospital; 2 Department of Radiology, 424 General Military Hospital; 3 Department of Radiology, Ippokration Hospital. Thessaloniki, Macedonia, Greece. Correspondence: Stergios A. Polyzos. 13 Simou Lianidi, 551 34 Thessaloniki, Macedonia, Greece. E-mail: stergios@endo.gr pylori (Hp) infection(23), have been proposed as cofounders of the multi-faceted pathogenesis of IR. Except for its conventional involvement in gastrointestinal diseases, Hp infection has been also implicated in a variety of extradigestive conditions, including cardiovascular, lung, hematologic, ophthalmic, skin, pancreatic, neurologic and hepatobiliary diseases(4, 11, 15, 27). Regarding IR-related morbidity, Hp infection may be implicated in the pathogenesis of obesity and type 2 diabetes mellitus (T2DM)(4, 11, 27, 29). Limited clinical data also suggest that Hp infection might contribute to the pathogenesis of NAFLD(9, 17, 28). We previously showed in an observational study that Hp infection may contribute to the pathogenesis NAFDL(19). If an association between Hp infection and NAFLD is validated, eradicating Hp infection Polyzos SA, Nikolopoulos P, Stogianni A, Romiopoulos I, Katsinelos P, Kountouras J. Effect of Helicobacter pylori eradication on hepatic steatosis, NAFLD fibrosis score and HSENSI in patients with nonalcoholic steatohepatitis: a MR imaging-based pilot open-label study 262 Arq Gastroenterol v. 51 no. 3 jul./set. 2014 might have therapeutic benefits in NAFLD treatment, which is currently an unmet need(24). Apart from the noninvasive indices of NAFLD fibrosis score and HSENSI [Homocysteine, serum glutamic oxaloacetic transaminase (SGOT), Erythrocyte sedimentation rate, Nonalcoholic Steatohepatitis Index] in NASH patients, there are also many noninvasive imaging modalities in the radiological armamentarium, namely, ultrasonography, computed tomography, and magnetic resonance imaging (MRI), to provide an accurate assessment of intrahepatic fat content(10, 25). Specifically, various MRI-based techniques, including chemical shift imaging (CSI), frequency-selective imaging and MR spectroscopy, are currently in clinical use for the detection and quantification of fat-water admixtures, with each technique having significant advantages, disadvantages, and limitations(25). These techniques permit the breakdown of the net MR signal into fat and water signal components, permitting the quantification of fat in hepatic tissue, and are progressively being used in the diagnosis, therapy and follow up of NAFLD patients(6). In this respect, the primary endpoint of this pilot study was the effect of Hp eradication treatment on hepatic steatosis (MRI-based) and the noninvasive indices of NAFLD fibrosis score and HSENSI in NASH patients, asymptomatic for gastrointestinal disease. Secondary endpoint was the effect of Hp eradication treatment on anthropometric parameters, liver function tests and other NAFLD-related parameters.