The Prevalence of Helicobacter pylori Infection in Korean Patients with Inflammatory Bowel Disease, a Multicenter Study

Abstract

Background/Aims: The prevalence of Helicobacter pylori (H. pylori) infection has been reported to be lower in individuals with inflammatory bowel disease (IBD) in some Western countries. We investigated H. pylori infection in Korean patients with IBD and any possible associations of H. pylori infection with drug therapy for IBD and the phenotype of Crohn’s disease (CD).

Methods: We studied 316 unselected patients with IBD, including 169 ulcerative colitis (UC) patients and 147 with CD, and the control group consisted of 316 age- and gender- matched healthy people who received a comprehensive medical examination for a regular checkup purpose. Infection rates of H. pylori as detected by the urea breath test were compared between the IBD patients and the controls.

Results: A statistically significant difference in H. pylori infection rate was noticed between the IBD patients (25.3%) and the controls (52.5%; p＜0.001), and between UC (32.0%) and CD patients (17.7%; p=0.04). Among the IBD patients, the age group of ＜60 and individuals with a history of taking metronidazole (13.0%; p=0.038) or ciprofloxacin (6.7%; p=0.001) were found to have a meaningfully lower infection rate, but those who did not take antibiotics still showed H. pylori infection rate significantly lower than the controls (CD 22.0% vs. UC 33.8% vs. Control 52.5%, p＜0.001). With an exception of age, phenotypic characteristics showed no significant relations with H. pylori infection rate in CD patients.

Conclusions: Korean patients with IBD, particularly CD, were found to have a significantly lower H. pylori infection rate than the controls. This association was more evident in those ＜60 years old, which suggested that H. pylori infection might be deemed to lower possible risks of IBD in younger adults.

목적: 국외 연구에서 염증성 장질환 환자에서 H. pylori 감염률은 일반인보다 낮다고 한다. 이에 국내 염증성 장질환 환자들에서 H. pylori 감염률을 알아보고, IBD 치료약제나 표현형과 관계가 있는지 조사하였다.

대상 및 방법: 2004년 11월부터 2006년 4월까지 국내 6개 의료기관의 외래를 방문한 169명의 궤양성대장염 환자와 147명의 크론병 환자들을 대상으로 전향 연구를 시행하였다. 염증성 장질환 환자들과 같은 날 상부위장관 및 대장내시경을 포함한 건강검진을 받은 수진자(염증성 장질환이 없는 것으로 확인된)중 성별과 나이가 일치한 316명을 대조군으로 선정하였다.

결과: 염증성장질환 환자의 H. pylori 감염률은 25.3% (궤양성대장염 32.0%, 크론병 17.7%)로 대조군(52.5%)에 비해 통계적으로 유의하게 낮았다. 염증성 장질환 환자 중 특히 60세 미만, metronidazole이나 ciprofloxacin을 복용한 경우 H.pylori 감염률이 낮았지만, 항생제 복용력이 없는 경우에도 대조군에 비해 H. pylori 감염률이 낮았다. 크론병의 표현형에 따른 H. pylori 감염률의 차이는 없었다.

결론: 국내 염증성 장질환 환자들은 대조군에 비해 H. pylori 감염률이 낮았고 이러한 현상은 특히 60세 미만에서 두드러졌다.