Is Helicobacter Pylori Infection Associated with Insulin Resistance? A Tertiary Care Centre Experience at Kattankulathur, Tamil Nadu, India

Introduction: H.pylori is the most common infection leading to gastrointestinal and extra-gastrointestinal lesions. Few studies had studied about H.pylori’s effect on glucose metabolism and insulin resistance and found thatH.pylori is associated with increase in mean Glycated Haemoglobin (HbA1c) levels and insulin resistance. But few studies have found no association between H.pylori and glucose metabolism.

Aim: To determine the relationship between H.pylori infection and glucose metabolism profiles in dyspeptic patients, based on the histopathological examination.

Materials and Methods: This prospective case-control study was carried out in the Department of Pathology at SRM Medical College Hospital and Research Centre from April 2021 to September 2021 on 70 dyspeptic patients. They were split into two groups: H.pylori positive (Group I, n=35) and H.pylori negative (Group II, n=35) groups. The age and gender of Group I were matched with Group II. Endoscopic gastric biopsy was taken and tissue sections were stained with Haematoxylin and Eosin (H&E), and Immunohistochemical (IHC) stain using H.pylori (Clone: EP279) rabbit monoclonal antibody. Blood samples were collected to test Fasting Blood Glucose (FBG) and insulin. Insulin resistance was calculated using Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Histomorphological changes and H.pylori colonisation were graded according to Updated Sydney System and correlated with HOMA-IR levels. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 22.0.

Results: There was no significant variation between H.pylori positive and negative groups in demographic variables such as age (p-value=0.45) and gender (p-value=0.23). Body Mass Index (BMI) and H.pylori infection showed statistically significant association (p-value=0.04). Increase in mean values of FBG, insulin and HOMA-IR were statistically associated with H.pylori positive (p-value <0.05). Degree of H.pylori bacterial density (rs=0.2992), chronic inflammation (rs=0.3193), activity (rs=0.4576) and atrophy (rs=0.2542) were positively correlated with HOMA-IR.

Conclusion: This study showed that chronic active gastritis with atrophic related changes and H.pylori colonisation were significantly correlated with HOMA-IR. Patients with H.pylori induced gastritis should be followed with regular monitoring of HOMA-IR; as early diagnosis and eradication of H.pylori might reduce the risk of insulin resistance and glucose metabolism dysregulation.