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. 2022 May 23;17(5):e0265323.
doi: 10.1371/journal.pone.0265323. eCollection 2022.

Effects of Helicobacter pylori treatment on the incidences of autoimmune diseases and inflammatory bowel disease in patients with diabetes mellitus

Nai-Wei Sheu  1 , Shu-Heng Huang  1 , Deng-Chyang Wu  2 , John Y Kao  3 , Kun-Der Lin  1   4
Affiliations

Effects of Helicobacter pylori treatment on the incidences of autoimmune diseases and inflammatory bowel disease in patients with diabetes mellitus

Nai-Wei Sheu et al. PLoS One. .

Abstract

Background: Helicobacter pylori infection is known to decrease the incidences of autoimmune diseases and inflammatory bowel disease(IBD). Our aim was investigating the effect of H. pylori treatment in diabetes mellitus(DM) patients.

Methods: Adults with newly-diagnosed H. pylori infection or peptic ulcer disease(PUD) within the general population and DM population were identified from the National Health Insurance Research Database of Taiwan from 2000-2010. 79,181 patients were assigned to the 3 groups: general population with PUD without H. pylori treatment(PUD-HPRx in general population), DM patients with PUD without H. pylori treatment(PUD-HPRx in DM), and DM patients with PUD who received H. pylori treatment(PUD+HPRx in DM).

Results: Higher incidences of autoimmune diseases and IBD were observed in the PUD+HPRx in DM group than in the PUD-HPRx in general population and PUD-HPRx in DM groups (autoimmune diseases = 5.14% vs 3.47% and 3.65%; IBD = 5.60% vs 3.17% and 3.25%; P<0.0001). A lower all-cause mortality was noted in the PUD+HPRx in DM group (HR: 0.937, P<0.001) than in the PUD-HPRx in DM group. Trends of a higher incidence of IBD and a lower mortality in younger patients in the PUD+HPRx in DM group compared with the PUD-HPRx in DM group were noted.

Conclusions: The results revealed that H. pylori treatment increased the incidences of autoimmune diseases and IBD and decreased the all-cause mortality in the DM group with PUD. The effect was more significant in younger patients. This finding assists in realizing the influence of H. pylori treatment in the DM population.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of the study design.
PUD+HPRx, peptic ulcer disease with Helicobacter pylori treatment; PUD-HPRx, peptic ulcer disease without Helicobacter pylori treatment; DM, diabetes mellitus; AD, autoimmune disease; IBD, inflammatory bowel disease.
Fig 2
Fig 2. Cumulative incidence of IBD with a two-year washout period.
Higher cumulative incidence of IBD in DM patients with peptic ulcer disease with Helicobacter pylori treatment (PUD+HPRx in DM) as compared with the general population with peptic ulcer disease without Helicobacter pylori treatment (PUD-HPRx in general population) and with DM patients with peptic ulcer disease without Helicobacter pylori treatment (PUD-HPRx in DM).
Fig 3
Fig 3. Cumulative survival rate.
Lower cumulative survival rate in DM patients with peptic ulcer disease without Helicobacter pylori treatment (PUD-HPRx in DM) as compared with DM patients with peptic ulcer disease with Helicobacter pylori treatment (PUD+HPRx in DM) and with the general population with peptic ulcer disease without Helicobacter pylori treatment (PUD-HPRx in general population). Kaplan-Meier curves estimated the probability of survival rate.
Fig 4
Fig 4. Forest plots of the PUD+HPRx and PUD-HPRx in DM groups.
A higher hazard ratio of the incidence rate of IBD was noted in the younger patients in the PUD+HPRx in DM group, while a lower hazard ratio of the mortality rate was noted in the younger patients in the PUD+HPRx in DM group.
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