Low prevalence of Helicobacter pylori infection among patients with inflammatory bowel disease

Background There is some preliminary evidence to suggest that patients with inflammatory bowel disease (IBD) are less frequently infected with Helicobacter pylori than the general population. Aim To examine whether the prevalence of Helicobacter pylori (H. pylori) is lower among IBD patients compared with non-IBD individuals based on results from surgical pathology. Methods From a database of surgical pathology reports, we recruited a sample of unique patients who underwent a same-day bidirectional gastrointestinal endoscopy with biopsies. Of the total 65 515 patients, 1061 served as cases with IBD and 64 451 as controls without IBD. The histological presence of H. pylori was correlated with the patients' demographic characteristics and histological presence of any oesophageal disease, Crohn's disease (CD), ulcerative colitis (UC) and indeterminate colitis (IND).Results were expressed as odds ratios (OR), using multivariate logistic regression to adjust for the cofounding influence of comorbidities and demographic characteristics. Results The presence of H. pylori was inversely associated with IBD, the adjusted OR and their 95% confidence intervals being 0.48 (0.27-0.79) for CD, 0.59 (0.39-0.84) for UC and 0.43 (0.15-0.95) for IND. In contradistinction, H. pylori -negative gastritis was positively associated with IBD, the adjusted OR being 11.06 (7.98-15.02) for CD, 2.25 (1.31-3.60) for UC and 6.91 (3.50-12.30) for IND. Conclusions Our study confirms an inverse association between H. pylori and IBD and a positive association between the H. pylori -negative gastritis and IBD. These relationships may open new avenues to study the pathogenesis of IBD.