C0534 - Helicobacter pylori Infection and Cag-A Strain Are Associated With NAFLD Severity

Introduction: Recent studies have suggested an association between Helicobacter pylori (Hpyl) and non-alcoholic fatty liver disease (NAFLD). However, epidemiologic studies attempting to determine this risk have yielded inconsistent results. The aim of the current study was to examine the association of Hpyl virulence genes and NAFLD in dyspeptic patients.

Methods: This is a prospective study from 2019 to 2020 in northeast Argentina. We evaluated 305 dyspeptic patients who fulfilled the ROME III criteria and underwent gastroscopy. Hpyl positivity (Hpyl-pos) was defined as gastric biopsy by Giemsa positive staining. Biochemical (AST, ALT, ALP, gGT, platelets, anti-HCV; HBsAg, Anti-HBc, Anti-HIV), clinical (BMI, smoking, alcohol intake, diabetes, hypertension), endoscopic and histological parameters were recorded. NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other known causes of liver diseases and significant alcohol consumption. The FIB-4 score was used to determine non-invasive fibrosis. DNA were extracted from Hpyl-pos gastric biopsies and analyzed in 105 subjects for cag-A, vac s1/s2, vac m1/m2 and oip-A.

Results: The prevalence of NAFLD was 39% (120/305), with Hpyl-pos 43% (56/131) and Hpyl-neg 37% (64/174) (p: ns), no associations were observed between Hpyl virulence genes and the presence of liver steatosis by ultrasound. When NAFLD subjects were analyzed, Hpyl-pos status was significantly associated with higher AST (Hpyl-pos: 35±14 UI/mL vs Hpyl-neg: 22±12 UI/mL, p: 0,0008), ALT (Hpyl-pos: 38±18 UI/mL vs Hpyl-neg: 30±17 UI/mL, p: 0,018) and FIB-4 (Hpyl-pos: 1,44±0,6 vs Hpyl neg: 1,16±0,7, p: 0,02). Indeed, Hpyl-pos infection was associated more proportion of patients with FIB-4 >1,3 (Hpyl-pos: 46% n: 30/56 vs Hpyl-neg: 29% n: 19/64, p: 0,0095), no difference was observed in FIB-4 >2,67. Moreover, presence of cag-A and vac-m1 were associated with higher AST (cag-A 36±12 UI/mL, p:0,002; vac-m1: 39±14 UI/mL, p: 0,0003). Also, higher FIB-4 values were observed in cag-A positive (1,49±0,5, p: 0,04) with more proportion of patients with FIB-4 >1,3 in cag-A positive: 55% (p: 0,04).

Discussion: In this prospective observational study no associations between Hpyl, virulence genes with NAFLD by ultrasound were observed. However, in NAFLD subjects Hpyl infection was associated with markers of liver injury and fibrosis . cag-A positive strain was associated with higher AST and FIB-4 values with more proportion of patients with FIB-4 >1,3.