Efeito da Erradicação do Helicobacter pylori nas concentracoes sanguineas da vitamina B12 e da homocisteina em idosos

Abstract

The interest in the association of Helicobacter pylori infection with cobalamin status is further triggered by the association of low cobalamin status with hyperhomocysteinemia which is a widely acknowledged risk factor of atherosclerosis, cognitive disorders and reduced quality of life. We aimed to evaluate the effect of H. pylori eradication on plasma vitamin B12 and homocysteine in elderly patients without pernicious anemia or other diseases associated with increased homocysteinemia. Among 108 consecutive patients whose vitamin B12 levels were 350 pg/mL, 72.6 years ( 7.93), 79 female (73.1%) and 29 male (26.9%), and who had normal folate level and had not previously been treated withcobalamin, 87 of initially selected patients were H. pylori positive and 21 were H. pylori negative. The negative group and 25 H. pylori infected patients were excluded from the study due to severe diseases. 62 H. pylori positive (11 male, 51 female, mean age 71.1 years, range 60-86 years) were included in the study. H. pylori positivity was based on a positive result of culture or two positive results among the other tests (performed urease test, carbolfuchsin stained smear or histological section, antibody anti-H. pyloriELISA and 13C-urea breath test).Gastritis was classified according to revised Sydney system. They were treated with omeprazole plus clatrithromycin and furazolidone for 7 days. Those patients who remained H. pylori infected were retreated. H. pylori eradication was defined as a negative 13C-urea breath test performed 3 and 6 months after the treatment. The 3-month eradication rate was 95.2% and 6-month was 100%. The initial B12 plasma levels increased from 196.2 pg/mL ( 66.0) to 256.6 pg/mL ( 98.5) and 284.4 pg/mL( 118.2), 3 and 6 months after treatment, respectively (p< 0.001 for both).Conversely, the initial homocysteine plasma levels decreased significantly (p < 10-3) after treatment (3 month, 16.5 mol/L 6.71; 6 month 21.6 mol/L 10.11) when compared with levels before treatment (40.3 mol/L 26.64). A significant decrease (p=0.02) in MCV was also observed 6 months after H. pylori eradication. Before treatment an inverse correlation was observed between B12 levels and MCV (r=-0.27, p=0.03), as well as between homocysteine and pepsinogen I (r=-0.317;p=0.01), but not between B12 and homocysteine levels (p=0.13). However, 3 (r=-0.37, p=0.004) and 6 (r=-0.31, p=0.02) months after H. pylori eradication, B12 and homocysteine levels were negatively correlated. Our results demonstrated that in elderly, H. pylori infection is associated with B12 deficiency and hyperhomocysteinemia. Also these patients may have a benifit with H. pylori eradication by improving their quality of life and decreasing risk of diseases associated with hyperhomocistenemia.