Effects of Anti– Helicobacter pylori Therapy on Incidence of Autoimmune Diseases, Including Inflammatory Bowel Diseases
Background & AimsHelicobacter pylori induces immune tolerance and is associated with a lower risk for immune-mediated disorders, such as autoimmune and inflammatory bowel diseases (IBD). We aimed to determine the effects of treatment for H pylori infection on the incidence of autoimmune disease...
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| Veröffentlicht in: | Clinical gastroenterology and hepatology 2019-09, Vol.17 (10), p.1991-1999 |
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| creator | Lin, Kun-Der Chiu, Guei-Fen Waljee, Akbar K Owyang, Stephanie Y El-Zaatari, Mohamad Bishu, Shrinivas Grasberger, Helmut Zhang, Min Wu, Deng-Chyang Kao, John Y |
| description | Background & AimsHelicobacter pylori induces immune tolerance and is associated with a lower risk for immune-mediated disorders, such as autoimmune and inflammatory bowel diseases (IBD). We aimed to determine the effects of treatment for H pylori infection on the incidence of autoimmune disease and IBD. MethodsWe collected data from the National Health Insurance Research Database in Taiwan on patients younger than 18 years old without a prior diagnosis of autoimmune disease or IBD. Patients with peptic ulcer disease (PUD) with treatment of H pylori infection (PUD+HPRx), PUD without H pylori treatment (PUD–HPRx), a urinary tract infection (UTI) treated with cephalosporin, or without PUD (controls) were matched for age, sex, insurance, and Charlson’s comorbidity index score. ResultsOf the 1 million patients we collected data from in 2005, we included 79,181 patients in the study. We compared the effects of treatment for H pylori infection on the risk of autoimmunity or IBD and found that PUD+HPRx has the highest adjusted hazard risk (aHR) for autoimmunity or IBD (aHR, 2.36), compared to PUD–HPRx (aHR, 1.91) or UTI (aHRs, 1.71) ( P < .001). The increased risk of autoimmune disease was not completely accounted for by antibiotic therapy alone, because PUD+HPRx had a higher aHR than UTI ( P < .001). A small but significant increase in mortality was observed in the PUD+HPRx cohort (aHR, 1.11; P = .001). ConclusionIn an analysis of data from the National Health Insurance Research Database in Taiwan, we found that treatment for H pylori infection is associated with a significant increase in the risk for autoimmune disease, including IBD. |
| doi_str_mv | 10.1016/j.cgh.2018.12.014 |
| format | Article |
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We aimed to determine the effects of treatment for H pylori infection on the incidence of autoimmune disease and IBD. MethodsWe collected data from the National Health Insurance Research Database in Taiwan on patients younger than 18 years old without a prior diagnosis of autoimmune disease or IBD. Patients with peptic ulcer disease (PUD) with treatment of H pylori infection (PUD+HPRx), PUD without H pylori treatment (PUD–HPRx), a urinary tract infection (UTI) treated with cephalosporin, or without PUD (controls) were matched for age, sex, insurance, and Charlson’s comorbidity index score. ResultsOf the 1 million patients we collected data from in 2005, we included 79,181 patients in the study. We compared the effects of treatment for H pylori infection on the risk of autoimmunity or IBD and found that PUD+HPRx has the highest adjusted hazard risk (aHR) for autoimmunity or IBD (aHR, 2.36), compared to PUD–HPRx (aHR, 1.91) or UTI (aHRs, 1.71) ( P < .001). The increased risk of autoimmune disease was not completely accounted for by antibiotic therapy alone, because PUD+HPRx had a higher aHR than UTI ( P < .001). A small but significant increase in mortality was observed in the PUD+HPRx cohort (aHR, 1.11; P = .001). ConclusionIn an analysis of data from the National Health Insurance Research Database in Taiwan, we found that treatment for H pylori infection is associated with a significant increase in the risk for autoimmune disease, including IBD.</description><identifier>ISSN: 1542-3565</identifier><identifier>EISSN: 1542-7714</identifier><identifier>DOI: 10.1016/j.cgh.2018.12.014</identifier><identifier>PMID: 30580094</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Anti-Bacterial Agents - therapeutic use ; Arthritis, Rheumatoid - epidemiology ; Arthritis, Rheumatoid - immunology ; Autoimmune Diseases - epidemiology ; Autoimmune Diseases - immunology ; Autoimmunity ; Bacteria ; Case-Control Studies ; Cephalosporins - therapeutic use ; Colitis, Ulcerative - epidemiology ; Colitis, Ulcerative - immunology ; Crohn Disease - epidemiology ; Crohn Disease - immunology ; Dermatomyositis - epidemiology ; Dermatomyositis - immunology ; Eradication ; Female ; Gastroenterology and Hepatology ; Helicobacter Infections - drug therapy ; Helicobacter Infections - epidemiology ; Helicobacter pylori - immunology ; Humans ; Immune Response ; Incidence ; Inflammatory Bowel Diseases - epidemiology ; Inflammatory Bowel Diseases - immunology ; Lupus Erythematosus, Systemic - epidemiology ; Lupus Erythematosus, Systemic - immunology ; Male ; Middle Aged ; Mortality ; Pemphigus - epidemiology ; Pemphigus - immunology ; Peptic Ulcer - epidemiology ; Polymyositis - epidemiology ; Polymyositis - immunology ; Proportional Hazards Models ; Scleroderma, Systemic - epidemiology ; Scleroderma, Systemic - immunology ; Sjogren's Syndrome - epidemiology ; Sjogren's Syndrome - immunology ; Taiwan - epidemiology ; Urinary Tract Infections - drug therapy ; Urinary Tract Infections - epidemiology ; Vasculitis - epidemiology ; Vasculitis - immunology</subject><ispartof>Clinical gastroenterology and hepatology, 2019-09, Vol.17 (10), p.1991-1999</ispartof><rights>AGA Institute</rights><rights>2019 AGA Institute</rights><rights>Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c572t-7cd94a9ba62f243eaa90963da2abaf691941c3ca7806bcf41d2987c288e1678d3</citedby><cites>FETCH-LOGICAL-c572t-7cd94a9ba62f243eaa90963da2abaf691941c3ca7806bcf41d2987c288e1678d3</cites><orcidid>0000-0003-1148-5915 ; 0000-0003-4823-5805 ; 0000-0003-1238-8324</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1542356518313909$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30580094$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lin, Kun-Der</creatorcontrib><creatorcontrib>Chiu, Guei-Fen</creatorcontrib><creatorcontrib>Waljee, Akbar K</creatorcontrib><creatorcontrib>Owyang, Stephanie Y</creatorcontrib><creatorcontrib>El-Zaatari, Mohamad</creatorcontrib><creatorcontrib>Bishu, Shrinivas</creatorcontrib><creatorcontrib>Grasberger, Helmut</creatorcontrib><creatorcontrib>Zhang, Min</creatorcontrib><creatorcontrib>Wu, Deng-Chyang</creatorcontrib><creatorcontrib>Kao, John Y</creatorcontrib><title>Effects of Anti– Helicobacter pylori Therapy on Incidence of Autoimmune Diseases, Including Inflammatory Bowel Diseases</title><title>Clinical gastroenterology and hepatology</title><addtitle>Clin Gastroenterol Hepatol</addtitle><description>Background & AimsHelicobacter pylori induces immune tolerance and is associated with a lower risk for immune-mediated disorders, such as autoimmune and inflammatory bowel diseases (IBD). We aimed to determine the effects of treatment for H pylori infection on the incidence of autoimmune disease and IBD. MethodsWe collected data from the National Health Insurance Research Database in Taiwan on patients younger than 18 years old without a prior diagnosis of autoimmune disease or IBD. Patients with peptic ulcer disease (PUD) with treatment of H pylori infection (PUD+HPRx), PUD without H pylori treatment (PUD–HPRx), a urinary tract infection (UTI) treated with cephalosporin, or without PUD (controls) were matched for age, sex, insurance, and Charlson’s comorbidity index score. ResultsOf the 1 million patients we collected data from in 2005, we included 79,181 patients in the study. We compared the effects of treatment for H pylori infection on the risk of autoimmunity or IBD and found that PUD+HPRx has the highest adjusted hazard risk (aHR) for autoimmunity or IBD (aHR, 2.36), compared to PUD–HPRx (aHR, 1.91) or UTI (aHRs, 1.71) ( P < .001). The increased risk of autoimmune disease was not completely accounted for by antibiotic therapy alone, because PUD+HPRx had a higher aHR than UTI ( P < .001). A small but significant increase in mortality was observed in the PUD+HPRx cohort (aHR, 1.11; P = .001). ConclusionIn an analysis of data from the National Health Insurance Research Database in Taiwan, we found that treatment for H pylori infection is associated with a significant increase in the risk for autoimmune disease, including IBD.</description><subject>Adult</subject><subject>Aged</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Arthritis, Rheumatoid - epidemiology</subject><subject>Arthritis, Rheumatoid - immunology</subject><subject>Autoimmune Diseases - epidemiology</subject><subject>Autoimmune Diseases - immunology</subject><subject>Autoimmunity</subject><subject>Bacteria</subject><subject>Case-Control Studies</subject><subject>Cephalosporins - therapeutic use</subject><subject>Colitis, Ulcerative - epidemiology</subject><subject>Colitis, Ulcerative - immunology</subject><subject>Crohn Disease - epidemiology</subject><subject>Crohn Disease - immunology</subject><subject>Dermatomyositis - epidemiology</subject><subject>Dermatomyositis - immunology</subject><subject>Eradication</subject><subject>Female</subject><subject>Gastroenterology and Hepatology</subject><subject>Helicobacter Infections - drug therapy</subject><subject>Helicobacter Infections - epidemiology</subject><subject>Helicobacter pylori - immunology</subject><subject>Humans</subject><subject>Immune Response</subject><subject>Incidence</subject><subject>Inflammatory Bowel Diseases - epidemiology</subject><subject>Inflammatory Bowel Diseases - immunology</subject><subject>Lupus Erythematosus, Systemic - epidemiology</subject><subject>Lupus Erythematosus, Systemic - immunology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Pemphigus - epidemiology</subject><subject>Pemphigus - immunology</subject><subject>Peptic Ulcer - epidemiology</subject><subject>Polymyositis - epidemiology</subject><subject>Polymyositis - immunology</subject><subject>Proportional Hazards Models</subject><subject>Scleroderma, Systemic - epidemiology</subject><subject>Scleroderma, Systemic - immunology</subject><subject>Sjogren's Syndrome - epidemiology</subject><subject>Sjogren's Syndrome - immunology</subject><subject>Taiwan - epidemiology</subject><subject>Urinary Tract Infections - drug therapy</subject><subject>Urinary Tract Infections - epidemiology</subject><subject>Vasculitis - epidemiology</subject><subject>Vasculitis - immunology</subject><issn>1542-3565</issn><issn>1542-7714</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks1u1DAUhSMEoj_wAGxQHoAJvnb-LKRKbSm0UiUWlLXl2DczHhx7ZCdF2fEOvGGfBIcpI2DBylfy-Y7lc26WvQJSAIH67bZQ601BCbQF0IJA-SQ7hqqkq6aB8unjzKq6OspOYtwSQnnJm-fZESNVSwgvj7P5qu9RjTH3fX7uRvPw_Ud-jdYo30k1Ysh3s_XB5HcbDHI3597lN04ZjU7hL2YavRmGyWH-3kSUEeObRWEnbdw6Tb2VwyBHH-b8wn9De5C9yJ710kZ8-XieZl8-XN1dXq9uP328uTy_XamqoeOqUZqXkneypj0tGUrJCa-ZllR2sq858BIUU7JpSd2pvgRNedso2rYIddNqdpqd7X13UzegVujGIK3YBTPIMAsvjfj7xpmNWPt7wWvKWVMlA9gbqOBjDNgfWCBi6UFsRepBLD0IoCL1kJjXfz56IH4HnwTv9gJMX783GERUZglVm5D6ENqb_9qf_UMra5xR0n7FGePWT8GlTAWImADxeVmEZQ-gZcBSfuwn-eCxiA</recordid><startdate>20190901</startdate><enddate>20190901</enddate><creator>Lin, Kun-Der</creator><creator>Chiu, Guei-Fen</creator><creator>Waljee, Akbar K</creator><creator>Owyang, Stephanie Y</creator><creator>El-Zaatari, Mohamad</creator><creator>Bishu, Shrinivas</creator><creator>Grasberger, Helmut</creator><creator>Zhang, Min</creator><creator>Wu, Deng-Chyang</creator><creator>Kao, John Y</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1148-5915</orcidid><orcidid>https://orcid.org/0000-0003-4823-5805</orcidid><orcidid>https://orcid.org/0000-0003-1238-8324</orcidid></search><sort><creationdate>20190901</creationdate><title>Effects of Anti– Helicobacter pylori Therapy on Incidence of Autoimmune Diseases, Including Inflammatory Bowel Diseases</title><author>Lin, Kun-Der ; Chiu, Guei-Fen ; Waljee, Akbar K ; Owyang, Stephanie Y ; El-Zaatari, Mohamad ; Bishu, Shrinivas ; Grasberger, Helmut ; Zhang, Min ; Wu, Deng-Chyang ; Kao, John Y</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c572t-7cd94a9ba62f243eaa90963da2abaf691941c3ca7806bcf41d2987c288e1678d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Arthritis, Rheumatoid - epidemiology</topic><topic>Arthritis, Rheumatoid - immunology</topic><topic>Autoimmune Diseases - epidemiology</topic><topic>Autoimmune Diseases - immunology</topic><topic>Autoimmunity</topic><topic>Bacteria</topic><topic>Case-Control Studies</topic><topic>Cephalosporins - therapeutic use</topic><topic>Colitis, Ulcerative - epidemiology</topic><topic>Colitis, Ulcerative - immunology</topic><topic>Crohn Disease - epidemiology</topic><topic>Crohn Disease - immunology</topic><topic>Dermatomyositis - epidemiology</topic><topic>Dermatomyositis - immunology</topic><topic>Eradication</topic><topic>Female</topic><topic>Gastroenterology and Hepatology</topic><topic>Helicobacter Infections - drug therapy</topic><topic>Helicobacter Infections - epidemiology</topic><topic>Helicobacter pylori - immunology</topic><topic>Humans</topic><topic>Immune Response</topic><topic>Incidence</topic><topic>Inflammatory Bowel Diseases - epidemiology</topic><topic>Inflammatory Bowel Diseases - immunology</topic><topic>Lupus Erythematosus, Systemic - epidemiology</topic><topic>Lupus Erythematosus, Systemic - immunology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Pemphigus - epidemiology</topic><topic>Pemphigus - immunology</topic><topic>Peptic Ulcer - epidemiology</topic><topic>Polymyositis - epidemiology</topic><topic>Polymyositis - immunology</topic><topic>Proportional Hazards Models</topic><topic>Scleroderma, Systemic - epidemiology</topic><topic>Scleroderma, Systemic - immunology</topic><topic>Sjogren's Syndrome - epidemiology</topic><topic>Sjogren's Syndrome - immunology</topic><topic>Taiwan - epidemiology</topic><topic>Urinary Tract Infections - drug therapy</topic><topic>Urinary Tract Infections - epidemiology</topic><topic>Vasculitis - epidemiology</topic><topic>Vasculitis - immunology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lin, Kun-Der</creatorcontrib><creatorcontrib>Chiu, Guei-Fen</creatorcontrib><creatorcontrib>Waljee, Akbar K</creatorcontrib><creatorcontrib>Owyang, Stephanie Y</creatorcontrib><creatorcontrib>El-Zaatari, Mohamad</creatorcontrib><creatorcontrib>Bishu, Shrinivas</creatorcontrib><creatorcontrib>Grasberger, Helmut</creatorcontrib><creatorcontrib>Zhang, Min</creatorcontrib><creatorcontrib>Wu, Deng-Chyang</creatorcontrib><creatorcontrib>Kao, John Y</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lin, Kun-Der</au><au>Chiu, Guei-Fen</au><au>Waljee, Akbar K</au><au>Owyang, Stephanie Y</au><au>El-Zaatari, Mohamad</au><au>Bishu, Shrinivas</au><au>Grasberger, Helmut</au><au>Zhang, Min</au><au>Wu, Deng-Chyang</au><au>Kao, John Y</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of Anti– Helicobacter pylori Therapy on Incidence of Autoimmune Diseases, Including Inflammatory Bowel Diseases</atitle><jtitle>Clinical gastroenterology and hepatology</jtitle><addtitle>Clin Gastroenterol Hepatol</addtitle><date>2019-09-01</date><risdate>2019</risdate><volume>17</volume><issue>10</issue><spage>1991</spage><epage>1999</epage><pages>1991-1999</pages><issn>1542-3565</issn><eissn>1542-7714</eissn><abstract>Background & AimsHelicobacter pylori induces immune tolerance and is associated with a lower risk for immune-mediated disorders, such as autoimmune and inflammatory bowel diseases (IBD). We aimed to determine the effects of treatment for H pylori infection on the incidence of autoimmune disease and IBD. MethodsWe collected data from the National Health Insurance Research Database in Taiwan on patients younger than 18 years old without a prior diagnosis of autoimmune disease or IBD. Patients with peptic ulcer disease (PUD) with treatment of H pylori infection (PUD+HPRx), PUD without H pylori treatment (PUD–HPRx), a urinary tract infection (UTI) treated with cephalosporin, or without PUD (controls) were matched for age, sex, insurance, and Charlson’s comorbidity index score. ResultsOf the 1 million patients we collected data from in 2005, we included 79,181 patients in the study. We compared the effects of treatment for H pylori infection on the risk of autoimmunity or IBD and found that PUD+HPRx has the highest adjusted hazard risk (aHR) for autoimmunity or IBD (aHR, 2.36), compared to PUD–HPRx (aHR, 1.91) or UTI (aHRs, 1.71) ( P < .001). The increased risk of autoimmune disease was not completely accounted for by antibiotic therapy alone, because PUD+HPRx had a higher aHR than UTI ( P < .001). A small but significant increase in mortality was observed in the PUD+HPRx cohort (aHR, 1.11; P = .001). ConclusionIn an analysis of data from the National Health Insurance Research Database in Taiwan, we found that treatment for H pylori infection is associated with a significant increase in the risk for autoimmune disease, including IBD.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30580094</pmid><doi>10.1016/j.cgh.2018.12.014</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-1148-5915</orcidid><orcidid>https://orcid.org/0000-0003-4823-5805</orcidid><orcidid>https://orcid.org/0000-0003-1238-8324</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Aged Anti-Bacterial Agents - therapeutic use Arthritis, Rheumatoid - epidemiology Arthritis, Rheumatoid - immunology Autoimmune Diseases - epidemiology Autoimmune Diseases - immunology Autoimmunity Bacteria Case-Control Studies Cephalosporins - therapeutic use Colitis, Ulcerative - epidemiology Colitis, Ulcerative - immunology Crohn Disease - epidemiology Crohn Disease - immunology Dermatomyositis - epidemiology Dermatomyositis - immunology Eradication Female Gastroenterology and Hepatology Helicobacter Infections - drug therapy Helicobacter Infections - epidemiology Helicobacter pylori - immunology Humans Immune Response Incidence Inflammatory Bowel Diseases - epidemiology Inflammatory Bowel Diseases - immunology Lupus Erythematosus, Systemic - epidemiology Lupus Erythematosus, Systemic - immunology Male Middle Aged Mortality Pemphigus - epidemiology Pemphigus - immunology Peptic Ulcer - epidemiology Polymyositis - epidemiology Polymyositis - immunology Proportional Hazards Models Scleroderma, Systemic - epidemiology Scleroderma, Systemic - immunology Sjogren's Syndrome - epidemiology Sjogren's Syndrome - immunology Taiwan - epidemiology Urinary Tract Infections - drug therapy Urinary Tract Infections - epidemiology Vasculitis - epidemiology Vasculitis - immunology |
| title | Effects of Anti– Helicobacter pylori Therapy on Incidence of Autoimmune Diseases, Including Inflammatory Bowel Diseases |
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