Harald-Morten Curth1, Johanna Dinter2, Kerstin Nigemeier3, Fabian Kütting4, Nicolas Hunzelmann5, Hans-Michael Steffen6. 1. Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. harald-morten.curth@uk-koeln.de. 2. Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. johanna.dinter@uk-koeln.de. 3. Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. k.nigemeier@googlemail.com. 4. Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. fabian.kuetting@uk-koeln.de. 5. Department of Dermatology and Venerology, University Hospital of Cologne, Cologne, Germany. hunzelmannn@uni-koeln.de. 6. Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. hans-michael.steffen@uk-koeln.de.
Abstract
BACKGROUND AND OBJECTIVE: Helicobacter pylori (Hp) infection has been hypothesised to play a major role in the pathogenesis of chronic spontaneous urticaria (CSU). Despite only weak evidence from Hp eradication studies, screening for Hp infection is still recommended in several CSU guidelines. The aim of this study was to investigate the effect of Hp eradication in combination with standard CSU treatment in Hp-positive compared with Hp-negative patients, applying the latest guidelines for both diseases. METHODS: 138 consecutive patients with CSU were enrolled in this retrospective cohort study. All patients underwent gastroscopy and Hp status was determined by urease testing and histologic examination. Seventy-five patients were diagnosed as Hp negative and 47 patients fulfilled criteria for definite Hp infection, 45 of whom received eradication therapy. Sixteen patients who received eradication therapy without an appropriate indication served as the medication control. All patients received symptomatic treatment with antihistamines and/or glucocorticoids regardless of Hp status. Partial response (PR) was defined as subjective amelioration of CSU symptoms; patients returning for further CSU treatment within 6 months were considered non-responders/relapsers (NRs). RESULTS: The prevalence of Hp infection was comparable with Hp seroprevalence data reported for healthy western populations. Standard treatment of CSU led to relief of symptoms independent of Hp status. Hp eradication by standard triple therapy had no additional effect on PR (p = 0.32) or NR (p = 0.50). CONCLUSIONS: Hp eradication has no discernible effect on CSU beyond that of standard CSU therapy. Therefore, Hp eradication should only be initiated in accordance with currently accepted indications of Hp treatment guidelines.
BACKGROUND AND OBJECTIVE:Helicobacter pylori (Hp) infection has been hypothesised to play a major role in the pathogenesis of chronic spontaneous urticaria (CSU). Despite only weak evidence from Hp eradication studies, screening for Hp infection is still recommended in several CSU guidelines. The aim of this study was to investigate the effect of Hp eradication in combination with standard CSU treatment in Hp-positive compared with Hp-negative patients, applying the latest guidelines for both diseases. METHODS: 138 consecutive patients with CSU were enrolled in this retrospective cohort study. All patients underwent gastroscopy and Hp status was determined by urease testing and histologic examination. Seventy-five patients were diagnosed as Hp negative and 47 patients fulfilled criteria for definite Hp infection, 45 of whom received eradication therapy. Sixteen patients who received eradication therapy without an appropriate indication served as the medication control. All patients received symptomatic treatment with antihistamines and/or glucocorticoids regardless of Hp status. Partial response (PR) was defined as subjective amelioration of CSU symptoms; patients returning for further CSU treatment within 6 months were considered non-responders/relapsers (NRs). RESULTS: The prevalence of Hp infection was comparable with Hp seroprevalence data reported for healthy western populations. Standard treatment of CSU led to relief of symptoms independent of Hp status. Hp eradication by standard triple therapy had no additional effect on PR (p = 0.32) or NR (p = 0.50). CONCLUSIONS:Hp eradication has no discernible effect on CSU beyond that of standard CSU therapy. Therefore, Hp eradication should only be initiated in accordance with currently accepted indications of Hp treatment guidelines.