Effects of Anti–Helicobacter pylori Therapy on Incidence of Autoimmune Diseases, Including Inflammatory Bowel Diseases

• DOI: 10.1016/j.cgh.2018.12.014
• Publication Date: 2018-12-20T08:47:18Z
• Authors: Kun-Der Lin; Guei-Fen Chiu; Akbar K. Waljee; Stephanie Y. Owyang; Mohamad El-Zaatari; Shrinivas Bishu; Helmut Grasberger; Min Zhang; Deng-Chyang Wu; John Y. Kao
• Keywords: Adult; Male; Helicobacter pylori; Incidence; Middle Aged; Inflammatory Bowel Diseases; Dermatomyositis; Anti-Bacterial Agents; Autoimmune Diseases; Cephalosporins; Helicobacter Infections; 3. Good health; Arthritis, Rheumatoid; 03 medical and health sciences; 0302 clinical medicine; Crohn Disease; Case-Control Studies; Humans; Lupus Erythematosus, Systemic; Colitis, Ulcerative; Female; Mortality; Aged

Helicobacter pylori induces immune tolerance and is associated with a lower risk for immune-mediated disorders, such as autoimmune and inflammatory bowel diseases (IBD). We aimed to determine the effects of treatment for H pylori infection on the incidence of autoimmune disease and IBD.We collected data from the National Health Insurance Research Database in Taiwan on patients younger than 18 years old without a prior diagnosis of autoimmune disease or IBD. Patients with peptic ulcer disease (PUD) with treatment of H pylori infection (PUD+HPRx), PUD without H pylori treatment (PUD-HPRx), a urinary tract infection (UTI) treated with cephalosporin, or without PUD (controls) were matched for age, sex, insurance, and Charlson's comorbidity index score.Of the 1 million patients we collected data from in 2005, we included 79,181 patients in the study. We compared the effects of treatment for H pylori infection on the risk of autoimmunity or IBD and found that PUD+HPRx has the highest adjusted hazard risk (aHR) for autoimmunity or IBD (aHR, 2.36), compared to PUD-HPRx (aHR, 1.91) or UTI (aHRs, 1.71) (P < .001). The increased risk of autoimmune disease was not completely accounted for by antibiotic therapy alone, because PUD+HPRx had a higher aHR than UTI (P < .001). A small but significant increase in mortality was observed in the PUD+HPRx cohort (aHR, 1.11; P = .001).In an analysis of data from the National Health Insurance Research Database in Taiwan, we found that treatment for H pylori infection is associated with a significant increase in the risk for autoimmune disease, including IBD.