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. 2024 Oct 25;16(10):e72363.
doi: 10.7759/cureus.72363. eCollection 2024 Oct.

Evaluation of Helicobacter pylori and Small Intestinal Bacterial Overgrowth in Subjects With Rosacea

Jessie M Nelson  1 , Jason M Rizzo  2 , Rachel K Greene  1 , Kathryn Fahlstrom  1 , Jonathan P Troost  3 , Yolanda R Helfrich  1 , Mio Nakamura  1
Affiliations

Evaluation of Helicobacter pylori and Small Intestinal Bacterial Overgrowth in Subjects With Rosacea

Jessie M Nelson et al. Cureus. .

Abstract

Background: Systemic abnormalities in the immune system may contribute to rosacea pathogenesis. Several studies have found a higher prevalence of abnormal bacterial growth, such as Helicobacter pylori (H. pylori) and small intestinal bacterial overgrowth (SIBO) in rosacea subjects. However, discrepancies remain in the literature, likely perpetuated by inconsistent testing methods and incomplete controlling for potential confounders.

Objective: We aimed to evaluate the prevalence of H. pylori and SIBO in rosacea subjects after controlling for several potential confounders.

Methods: This cross-sectional study evaluated subjects with papulopustular or erythematotelangiectatic rosacea. Subjects with previous or existing gastrointestinal (GI) disease, GI surgery, autoimmune disorders, immunosuppression, or significant comorbidities were excluded. Certain medication use (antibiotics, steroids, GI-modulating medications, anti-inflammatories) required an appropriate washout period. Rosacea history and severity were assessed. Subjects answered questions regarding their rosacea and GI health. H. pylori andSIBO were evaluated by 13C-urea breath test and glucose-breath test methods, respectively.

Results: Of 27 subjects, 14.8% (N=4) tested positive for H. pylori and 33.3% (N=9) tested positive for SIBO. Compared to the general population prevalence, the proportion of H. pylori in the rosacea cohort was significantly less (p=0.02). Though the estimated population prevalence of SIBO had a wider range, compared to midrange, the prevalence of SIBO in the rosacea cohort was greater (p<0.001). There were no significant associations between demographics, rosacea characteristics, or GI symptoms and H. pylori or SIBO positivity. Conclusion: When eliminating several potential confounders, SIBO is more prevalent in subjects with rosacea compared to the general population. Thus, SIBO may be associated with rosacea, though it remains incompletely understood whether SIBO itself contributes to rosacea pathophysiology or rather SIBO prevalence and rosacea are both downstream effects of abnormalities in systemic immunity. Future studies are warranted to elucidate this relationship further, though this observed association may be promising for novel therapeutic targets in rosacea treatment.

Keywords: h. pylori; immunity; inflammation; rosacea; sibo.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. University of Michigan Medical School Institutional Review Board (IRBMED) issued approval HUM00113147. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: This work was supported by a clinical research grant to JMR (American Acne and Rosacea Society) and an NCATS grant to JPT (UM1TR004404). The financial sponsors had no involvement in the study. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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