Abstract
Helicobacter pylori (H. Pylori) infection is associated with gastritis and peptic ulcer, but its relationship with gut graft versus host disease (GVHD) is unknown. We investigated the association between H. Pylori carriage and incidence and severity of mucosal toxicity and GVHD in 128 consecutive matched sibling stem cell transplantation (SCT) recipients. Using a verified enzyme linked immunosorbant assay (ELISA), 43.5% of patients had H. Pylori exposure before SCT. There was absolute concordance between serological and breath test data in 40 prospective cases. There was no increased risk in WHO grade 3 or 4 mucositis in H. Pylori carriers. Significant (grade II or above) overall GVHD was only predicted by preceding mucositis (p<0.001), while gut GVHD was associated with increased age (p=0.001) and mucositis (p=0.022). Despite increased incidence with age, H. Pylori carriage was associated with significantly reduced risk of gut GVHD (p=0.04) but not overall GVHD. The reduced risk of immune-mediated gut inflammation in H. Pylori carriers after SCT may be related to the known reduced incidence of inflammatory bowel disease in chronic H. Pylori carriers.
Similar content being viewed by others
References
Martino R, Romero P, Subira M, Bellido M, Altes A, Sureda A, et al (1999) Comparison of the classic Glucksberg criteria and the IBMTR Severity Index for grading acute graft-versus-host disease following HLA-identical sibling stem cell transplantation. International Bone Marrow Transplant Registry. Bone Marrow Transplant 24:283–287
Johansson JE, Ekman T (1997) Gastro-intestinal toxicity related to bone marrow transplantation: disruption of the intestinal barrier precedes clinical findings. Bone Marrow Transplant 19:921–925
Wardley AM, Jayson GC, Swindell R, Morgenstern GR, Chang J, Bloor R, et al (2000) Prospective evaluation of oral mucositis in patients receiving myeloablative conditioning regimens and haemopoietic progenitor rescue. Br J Haematol 110:292–299
Xia HH, Wong BC, Wong WM, Tang VS, Cheung HK, Sham FN, et al (2002) Optimal serological tests for the detection of Helicobacter pylori infection in the Chinese population. Aliment Pharmacol Ther 16:521–526
Chiu EK, Hawkins BR, Liang RH, Lie AK, Kwong YL, Chan TK (1995) Incidence of graft-versus-host disease in Hong Kong Chinese and its influence on survival after bone marrow transplantation from HLA-identical siblings. Bone Marrow Transplant 15:543–547
Weisdorf D, Hakke R, Blazar B, Miller W, McGlave P, Ramsay N, et al (1991) Risk factors for acute graft-versus-host disease in histocompatible donor bone marrow transplantation. Transplantation 51:1197–1203
Wong BC, Lam SK, Ching CK, Hu WH, Kwok E, Ho J, et al (1999) Differential Helicobacter pylori infection rates in two contrasting gastric cancer risk regions of South China. China Gastric Cancer Study Group. J Gastroenterol Hepatol 14:120–125
Tobin RW, Hackman RC, Kimmey MB, Durtschi MB, Hayashi A, Malik R, et al (1996) Bleeding from gastric antral vascular ectasia in marrow transplant patients. Gastrointest Endosc 44:223–229
Cruz-Correa M, Poonawala A, Abraham SC, Wu TT, Zahurak M, Vogelsang G, et al (2002) Endoscopic findings predict the histologic diagnosis in gastrointestinal graft-versus-host disease. Endoscopy 34:808–813
el-Omar E, Penman I, Cruikshank G, Dover S, Banerjee S, Williams C, et al (1994) Low prevalence of Helicobacter pylori in inflammatory bowel disease: association with sulphasalazine. Gut 35:1385–1388
Halme L, Rautelin H, Leidenius M, Kosunen TU (1996) Inverse correlation between Helicobacter pylori infection and inflammatory bowel disease. J Clin Pathol 49:65–67
Pearce CB, Duncan HD, Timmis L, Green JR (2000) Assessment of the prevalence of infection with Helicobacter pylori in patients with inflammatory bowel disease. Eur J Gastroenterol Hepatol 12:439–443
El-Omar EM, Chow WH, Rabkin CS (2001) Gastric cancer and H. pylori: Host genetics open the way. Gastroenterology 121:1002–1004
Yea SS, Yang YI, Jang WH, Lee YJ, Bae HS, Paik KH (2001) Association between TNF-alpha promoter polymorphism and Helicobacter pylori cagA subtype infection. J Clin Pathol 54:703–706
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Au, W.Y., Wong, R.W.M., Wong, B.C.Y. et al. Reduced incidence of acute graft versus host disease (GVHD) of the gut in Chinese carriers of Helicobacter Pylori during allogeneic bone marrow transplantation. Ann Hematol 83, 34–37 (2004). https://doi.org/10.1007/s00277-003-0780-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00277-003-0780-4