Helicobacter pylori and Chlamydia pneumoniae in primary care- cardiovascular and gastrointestinal aspects

Sammanfattning: Helicobacter pylori and Chlamydia pneumoniae are common infectious agents in the Swedish population, causing gastritis ulcers and respiratory infections. The metabolic syndrome is characterised by overweight, insulin resistance, hypertension, diabetes and dyslipidaemia. Sera from a patient cohort (n=531) originally examined in 1987-89 were investigated for previous infection of H. pylori and C. pneumoniae in order to find possible associations with the metabolic syndrome. When comparing patients who have suffered infections (n=245) from both agents combined with those without infection (n=57) a significant increase in fasting insulin was observed indicating that the double infection may influence peripheral insulin resistance, which in turn could influence manifest disease. In a gastroscopy patients cohort (n=166), we compared the ELISA and immunoblot (IB) serology for H. pylori, with the histological features of the gastric mucosa. The presence of metaplasia and atrophy in the antrum were associated with a more specific immunoblot pattern and immunoblot analysis had a better sensitivity for gastric mucosal changes than ELISA-H. pylori serology. In all patients with chronic gastritis (n=90) significant correlation was seen to the 59 and 65 kDa protein band and in the corpus of the stomach also to a 33 kD protein. Atrophic gastritis and metaplasia in the antrum were significantly correlated with immunoreactivity to the 62 kDa protein (p<0.001 vs. p<0.002). Atrial fibrillation, with largely unknown origin, is the most common form of cardiac arrythmia demanding treatment. In comparing a population with this condition at a cardiology clinic (n=54) with a matched control population (n=54) from the same geographical area we found a significant independent association between atrial fibrillation and seropositivity for the combination of H. pylori and C. pneumoniae infection. Anti-Secretory Factor (ASF) is a protein with potent anti-inflammatory and anti-secretory properties. The pathophysiology of IBS, a common disorder often impairing quality of life, is unknown but a disturbance of motility, sensitivity and secretory processes has been observed. In order to improve the general condition, half of a group of patients (n=82) with IBS were given special processed cereals for eight weeks and the remaining half were randomly given placebo diet. Both groups significantly improved in their general well-being after eight weeks of treatment but no difference was seen between the groups. Patients with H. pylori infection (n=11) showed a tendency towards benefiting from the active treatment (p=0.08). In a sub-group of patients with loose stools (n=14) the ASF level increased in the active diet group. In the individual patients there was also a significant correlation between the improvement of symptoms and the change of the ASF plasma levels (p<0.05). In conclusion, we have shown that chronic infections with H. pylori and C. pneumoniae may affect the biological processes in several organ systems. The common pathophysiological pathway is probably a chronic inflammation where either the histological changes or the agents mediating the inflammation are of greatest importance, e.g. cytokines.