Background: Helicobacter pylori (HP) infections are one of the few commonest worldwide which affects approximately 50% of the overall population. It is reported that high serum levels of C-reactive protein (CRP) is a novel cardiovascular risk factor that impairs endothelial function. H. Pylori infection in gastric mucosa may cause systemic inflammatory reaction. This study aimed to examine the association between the infection and serum high sensitivity C-reactive protein (hsCRP). Thus our study attempts to find the levels of microalbuminuria between H. pylori infected patients and non-infected patients in diabetes mellitus and establish its association with blood glucose levels. 

Materials and Methods: The case control study consists of 98 diabetic patients where 52 were clinically suspected case of H. Pylori infection and 46 without H. Pylori infection in medicine department. Serum hs CRP levels were determined with a high-sensitivity nephelometric method. Urinary albumin excretion was measured by nephelometric test for the measurement of microalbumin in urine. Three endoscopic biopsy samples were obtained from the antral mucosa of each patient. The first two biopsy samples were placed into 10% formol solution and dyed by Giemsa and hematoxylin-eosin while the third sample was given for rapid urease test and investigated for H. pylori.

Results: The presence of H. pylori infection was detected in 52 of 98 diabetic patients (53.06%). The ESR and hs-CRP levels were elevated in H. Pylori infected diabetes cases as compared to non-infected diabetics which were found statistically significant. The Microalbumin levels were higher in diabetic patients infected by H. pylori compared to non-infected patients (185.3 ± 90.5 vs 128.1 ± 42.6; p <0.001). However, a high positive correlation was observed between ESR with hs-CRP level (r = 0.825; P = <0.001) among H. Pylori infected diabetes subjects while no correlation was seen in non-infected diabetics (r = 0.279; P = 0.098). Conclusions: We have also observed an increase in hs-CRP and ESR levels in H.pylori infected diabetics which are also in confirmation with other fewer studies. Moreover, an association is observed between ESR and Hs-CRP in H. Pylori infected diabetics which suggest a plausible role in the pathogenesis and could be used as screening markers of the disease. hsCRP was higher among the infected individuals. The summary odd ratio indicated that H. pylori infection could influence the serum hsCRP level.

Keywords: Helicobacter pylori, Type 2 diabetes mellitus, Microalbuminuria, hs-CRP, ESR.

1. Wotherspoon AC, Ortiz-Hidalgo C, Falzon MR, Isaacson PG. Helicobacter pylori-associated gastritis and primary B-cell gastric lymphoma. Lancet 1991; 338:1175–1176. 
2. Parsonnet J. Helicobacter pylori and gastric cancer. Gastroenterol Clin North Am 1993; 22:89–104.
3. Malaty HM. Epidemiology of Helicobacter pylori infection. Best Pract Res Clin Gastroenterol 2007; 21:205–214. 
4. Graham DY, Osato MS, Olson CA, Zhang J, Figura N. Effect of H. pylori infection and CagA status on leukocyte counts and liver function tests: extra-gastric manifestations of H. pylori infection. Helicobacter 1998; 3:174–178. 
5. Perri F, Clemente R, Festa V, De Ambrosio CC, Quitadamo M, Fusillo M, Grossi E, Andriulli A. Serum tumour necrosis factor-alpha is increased in patients with Helicobacter pylori infection and CagA antibodies. Ital J Gastroenterol Hepatol 1999; 31:290–294. 
6. Patel P, Mendall MA, Khulusi S, Northfield TC, Strachan DP. Helicobacter pylori infection in childhood: risk factors and effect on growth. BMJ 1994; 309:1119–1123. 
7. van Dieren S, Beulens JW, van der Schouw YT, Grobbee DE, Neal B. The global burden of diabetes and its complications: an emerging pandemic. Eur J Cardiovasc Prev Rehabil 2010;17 Suppl 1:S3–S8.
8. Qi L, Hu FB, Hu G. Genes, environment, and interactions in prevention of type 2 diabetes: a focus on physical activity and lifestyle changes. Curr Mol Med 2008;8: 519–532. 
9. Agardh E, Allebeck P, Hallqvist J, Moradi T, Sidorchuk A. Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int J Epidemiol 2011; 40:804–818.
10. Papamichael KX, Papaioannou G, Karga H, Roussos A, Mantzaris GJ. Helicobacter pylori infection and endocrine disorders: is there a link? World J Gastroenterol 2009; 15:2701–2707. 
11. Donath MY, Shoelson SE. Type 2 diabetes as an inflammatory disease. Nat Rev Immunol 2011; 11:98–107. 
12. Devrajani BR, Shah SZA, Soomro AA, Devrajani T. Type 2 diabetes mellitus: a risk factor for Helicobacter pyloriinfect-ion: a hospital based case-control study. International Journal of Diabetes in Developing Countries 2010;30(1):22–26.
13. Vafaeimanesh J, Parham M, Seyyedmajidi M, Bagherzadeh M. Helicobacter pylori infection and insulin resistance in diabetic and nondiabetic population. Scientific World Journal 2014; 2014:5.
14. Talebi-Taher M, Mashayekhi M, Hashemi MH, Bahrani V. Helicobacter pyloriin diabetic and non-diabetic patients with dyspepsia. Acta Medica Iranica 2012; 50(5):315–318. 
15. Hamed SA, Amine NF, Galal GM, et al. Vascular risks and complications in diabetes mellitus: the role of Helicobacter pyloriJournal of Stroke and Cerebrovascular Diseases 2008; 17(2):86–94.
16. Sargin M, Uygur-Bayramiçli O, Sargýn H, Orbay E, Yavuzer D, Yayla A. Type 2 diabetes mellitus affects eradication rate of Helicobacter pylori. World Journal of Gastroenterology 2003; 9(5):1126–1128.
17. Chung GE, Heo NJ, Park MJ, Chung SJ, Kang HY, Kang SJ. Helicobacter pylori seropositivity in diabetic patients is associated with microalbuminuria. World Journal of Gastroenterology2013;19(1):97–102.
18. Demir M, Gokturk HS, Ozturk NA, Kulaksizoglu M, Serin E, Yilmaz U. Helicobacter pylori prevalence in diabetes mellitus patients with dyspeptic symptoms and its relationship to glycemic control and late complications. Digestive Diseases and Sciences2008;53(10):2646–2649.
19. Tseng CH. Diabetes, insulin use and  Helicobacter pylorieradication: a retrospective cohort study. BMC Gastroenterology 2012; 12, article 46 doi: 10.1186/1471-230x-12-46.
20. Caramori M, Fioretto P, Mauer M. The need for early predictors of diabetic nephropathy risk: is albumin excretion rate sufficient? Diabetes 2000; 49: 1399-408.
21. Lo MKW, Lee KF, Chan NN, et al. Effects of gender, Helicobacter pylori and hepatitis B virus serology status on cardiovascular and renal complications in Chinese type 2 diabetic patients with overt nephropathy. Diabetes Obes Metab 2004; 6: 223-30.
22. DeMeyer GR, Herman AG. Vascular endothelial dysfunction. Prog Cardiovasc Dis 1997; 39; 325-42.
23. Corrado E, Nova S. Role of inflammation and infection in vascular disease. Acta Chir Belg 2005; 105: 567-79.
24. Oshima T, Ozano R, Yano Y, et al. Association of Helicobacter pylori infection with systemic inflammation and endothelial dysfunction in healthy male subjects. J Am Coll Cardiol 2005; 45: 1219-22.
25. Cong He, Zhen Yang, Nong-Hua Lu. Helicobacter pyloriinfection and diabetes: Is it a myth or fact? World J Gastroenterol 2014; 20(16): 4607–4617.
26. Gentile S, Turco S, Oliviero B, Torella R. The role of autonomic neuropathy as a risk factor of Helicobacter pyloriinfection in dyspeptic patients with type 2 diabetes mellitus. Diabetes Research and Clinical Practice 1998; 42(1):41–48.
27. Marrollo M, Latella G, Melideo D, et al. Increased prevalence of Helicobacter pyloriin patients with diabetes mellitus.  Digestive and Liver Disease 2001; 33(1):21–29.
28. Anastasios R, Goritsas C, Papamihail C, Trigidou R, Garzonis P, Ferti A. Helicobacter pylori infection in diabetic patients: prevalence and endoscopic findings. European Journal of Internal Medicine2002;13(6):376–379.
29. Borody T, Ren Z, Pang G, Clancy R. Impaired host immunity contributes to Helicobacter pylori eradication failure. Am J Gastroenterol 2002; 97:3032–3037.
30. Jeon CY, Haan MN, Cheng C, Clayton ER, Mayeda ER, Miller JW, et al. Helicobacter pylori infection is associated with an increased rate of diabetes. Diabetes Care 2012; 35:520–525.
31. de Luis DA, de la Calle H, Roy G, de Argila CM, Valdezate S, Canton R, Boixeda D. Helicobacter pylori infection and insulin-dependent diabetes mellitus. Diabetes Res Clin Pract 1998; 39:143–146.
32. Yudkin JS, Stehouwer CDA, Emeis JJ, Coppack SW. C-reactive protein in healthy subjects: associations with obesity,insulin resistance and endothelial dysfunction: a potential role of cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol 1999; 19: 972-8.
33. Ross R. Atherosclerosis - an inflammatory disease. N Engl J Med 1999; 340: 115-26.
34. Pietroiusti A, Giuliano M, Magrini A, et al. Cytotoxin-associated gen A strains of Helicobacter pylori represent a risk factor for the development of microalbuminuria in type 2 diabetes. Diabetes Care 2006; 29: 1399-401.
35. Hamed SA, Amine NF, Galal GM, et al. Vascular risks and complications in diabetes mellitus: the role of Helicobacter pylori J Stroke Cerebrovasc Dis 2008; 17: 86-94.

Mr Krishanu Pal

Tutor, Department of Microbiology,

ICARE Institute of Medical Sciences and Research, Haldia, West Bengal, India

Ph: +91- (M) 9007474520, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.