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Potential Impact of Active H. pylori Infection-Related Metabolic Syndrome on Preeclampsia Among Pregnant Women [Letter]

Authors Tzitiridou-Chatzopoulou M , Gialamprinou D, Kountouras J

Received 14 June 2022

Accepted for publication 23 June 2022

Published 4 July 2022 Volume 2022:14 Pages 845—846


Checked for plagiarism Yes

Editor who approved publication: Dr Everett Magann

Maria Tzitiridou-Chatzopoulou,1,2 Dimitra Gialamprinou,3 Jannis Kountouras1

1Department of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Macedonia, Greece; 2School of Healthcare Sciences, Midwifery Department, University of West Macedonia, Kozani, Macedonia, 50100, Greece; 3Second Neonatal Department and NICU, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Macedonia, 56403, Greece

Correspondence: Jannis Kountouras, Professor of Medicine, Gastroenterologist, 8 Fanariou St, Byzantio, Thessaloniki, Macedonia, 551 33, Greece, Tel +30-2310-892238, Fax +30-2310-892744, Email [email protected]; [email protected]

View the original paper by Dr Tsegaye and colleagues

Dear editor

In their case control study, Tsegaye et al1 by introducing the stool antigen test (SAT) for the diagnosis of Helicobacter infection (Hp-I) concluded that Hp-I is linked with preeclamptic pregnant women in Ethiopia associated with metabolic syndrome (MetS) parameters such as body mass index, diabetes mellitus, dyslipidemia and arterial hypertension.

Although the SAT has been introduced broadly in Africa, the limitation of this study, as also mentioned by others2 is that only the SAT was used. By introducing several diagnostic approaches increases the detection of Hp-I.2

Specifically, despite the advantages (easy to perform and rapid for Hp detection), SATs display several disadvantages. Because the principle of SAT is an antigen–antibody reaction, differences in antigens used for SAT in different geographic regions may cause heterogeneity of results; the diagnostic performances of different SATs are heterogeneous, and this could relate to the designs of the test like enzyme immunoassay and immunochromatographic assay (ICA) and for the selection of antibody, such as monoclonal antibody and polyclonal antibody. SAT shows a high rate of false positivity. Moreover, SAT negative results may not signify the absence of Hp-I because the low gastric colonization of bacteria results in low concentration of Hp antigen in the sample. Furthermore, concerning ICA-based methods, subjective interpretation of the results, especially for the tracing line, makes it problematic to diagnostic accuracy. The accuracy of SAT is influenced by several factors, including antibiotics, proton pump inhibitors, N-acetylcysteine, bowel movement and upper gastrointestinal tract bleeding. Preservation of the specimen, like temperature and transport time before testing, and cut-off valve also have impacts on the SAT diagnostic accuracy; if study results are not compared to the gold standard examinations for the diagnosis of active Hp-I (histology, rapid urease test, culture or urea breath test), positive or negative results are still controversial.

In this regard, important to note that, only active Hp-I induces humoral and cellular immune responses that, owing to the sharing of homologous epitopes (molecular mimicry), cross-react with components of the host, thereby contributing and possibly perpetuating Hp-related systemic disorders3,4 including preeclampsia.5 In this respect, maternal inflammatory immune reactions appear to be involved in the pathogenesis of preeclampsia; several studies of both patients and animal models have established that changes in the immune system (cellular plus humoral immunity and/or adaptive-innate immunity) could contribute to the pathophysiology of preeclampsia.

Hp-I, a worldwide burden with a mean global prevalence of 58% and accounting of about 4.4 billion of Hp infected individuals, is also related with MetS-systemic systemic pathologies such as preeclampsia, cardio-cerebrovascular, and neurodegenerative diseases, the end outcomes of MetS;3–5 and it appears to be a critical risk factor of MetS in pregnancy and influences the occurrence of many opposing pregnancy outcomes5 such as gestational diabetes mellitus, arterial hypertension, hyperemesis of pregnancy, preeclampsia in obese or overweight pregnant women, fetal growth restriction, premature delivery, abortion, Hp-I of newborn, and neural tube defects. Moreover, eradicating Hp-I may reduce or delay such systemic pathologies.3

Therefore, active Hp-I-related MetS may affect pregnancy critical outcomes, Hp eradication may benefit pregnant women and their neonates and thus further studies are needed.


The authors report no conflicts of interest in this communication.


1. Tsegaye N, Diriba R, Araya S. Magnitude of H. pylori and its association with preeclampsia among pregnant women in Ethiopia: a Case Control Study. Int J Womens Health. 2022;14:635–642. doi:10.2147/IJWH.S363137

2. Yisak H, Belete D, Mahtsentu Y. Helicobacter pylori infection and related factors among pregnant women at Debre Tabor General Hospital, Northwest Ethiopia, 2021. Anemia Highly Related H Pylori Womens Health. 2022;18:17455057221092266. doi:10.1177/17455057221092266

3. Kountouras J, Doulberis M, Polyzos SA, et al. Impact of Helicobacter pylori and/or Helicobacter pylori-related metabolic syndrome on incidence of all-cause and Alzheimer’s dementia. Alzheimers Dement. 2019;15(5):723–725. doi:10.1016/j.jalz.2019.01.008

4. Kountouras J, Papaefthymiou A, Polyzos SA, et al. Impact of Helicobacter pylori-Related metabolic syndrome parameters on arterial hypertension. Microorganisms. 2021;9(11):2351. doi:10.3390/microorganisms9112351

5. Zhou B, Wang F. Research progress in relation of Helicobacter pylori infection with pregnancy-related diseases and adverse pregnancy outcomes. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2020;45(3):338–344. doi:10.11817/j.issn.1672-7347.2020.190032

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