The frequency of Helicobacter pylori infection in patients with primary antibody deficiencies

Document Type: Original Article

Authors

1 Research Center for Immunodeficiencies, Children's Medical Center , Tehran University of Medical Science , Tehran , Iran

2 Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran

3 Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran

4 Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 Department of Allergy and Clinical Immunology, Rasool e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

6 Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran

7 Department of Immunology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran

8 Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran, and the University of Medical Science, Tehran, Iran

9 Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

10.22034/igj.2019.190155.1014

Abstract

Introduction: Primary antibody deficiencies (PADs) are the most common inherited immunodeficiencies, which can present wide clinical presentation including susceptibility to bacterial infections and gastric adenocarcinoma. Since Helicopter pylori (H.pylori) infection is associated with immune dysregulation and an increased risk of gastric carcinogenesis, we evaluated the prevalence of HP infection in patients with different forms of PAD.
Methods: Thirty-seven patients with common variable immunodeficiency (CVID), 23 patients with X-linked agammaglobulinemia (XLA), and eleven patients with hyper IgM syndrome (HIgM, age range 8-25; 47 males and 24 females) were screened for H.pylori infection by Urea breath test (UBT) and H.pylori stool antigen (HPSA). Subsequently, an upper gastrointestinal endoscopy was conducted only for patients who had UBT and HPSA positive results due to an established gastrointestinal indication.
Results: Although almost all patients were under prophylactic antibiotic therapy, H.pylori infection was detected in 28% (n=20) of the patients; among different forms of PAD, 29% (n=11) of CVID patients, 30% (n=7) of XLA, and 18% (n=2) of HIgM patients were infected. Among patients with H.pylori infection, the rate of parasite infections was higher, while the prevalence of autoimmunity and autoinflammatory disorders increased in patients without H.pylori infection.
Conclusions: Despite regular immunoglobulin replacement therapy and antibiotic prophylaxis, one-fourth of PAD patients had a persistent H.pylori infection though without severe gastrointestinal manifestations. Long-term follow-up of these selected patients is essential to evaluate its association with gastric cancers.

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