Insulin-dependent diabetes mellitus affects eradication rate of Helicobacter pylori infection

Background Patients with insulin-dependent diabetes mellitus (IDDM) are oft en affected by chronic infections; however, antibiotic absorption may be in fluenced by the disease. Helicobacter pylori, the most common gastric infec tion worldwide, is the main acquired factor in the pathogenesis of gastriti s and peptic ulcer. The aim of the study was to compare the H. pylori eradi cation rate obtained with a standard 7-day antibiotic regimen in a group of IDDM H. pylori infected patients and in a control group of infected dyspep tic patients. Methods Thirty-one patients (18 male, 13 female, 39 +/- 12 years) affected by IDDM and H. pylori infection, and 50 dyspeptic infected patients (23 mal e, 17 female, 37 +/- 10 years) were evaluated. H. pylori infection was asse ssed through C-13-urea breath test. A triple therapy with amoxycillin (1 g b.i.d.), clarithromycin (250 mg t.i.d.) and pantoprazole (40 mg b.i.d.) was given to both groups at the time of diagnosis for 7 days. Cure was defined as the absence of H. pylori infection, assessed by C-13-urea breath test. 6 weeks after completing anti-microbial therapy. Effects of H, pylori eradi cation on gastrointestinal symptoms (pyrosis, epigastric pain, belching, bl oating, halitosis and nausea) were also evaluated. Results All enrolled patients completed the study. When compared to dyspept ic patients, the eradication rate was significantly lower in IDDM patients: 92% (46/50) versus 65% (20/31), respectively (P < 0.002). IDDM patients in fected by H. pylori showed a different prevalence of some of the gastrointe stinal symptoms assessed when compared to the infected dyspeptic patients; in particular, pyrosis, epigastric pain and belching were significantly mor e prevalent in the infected dyspeptic group. After H. pylori eradication, b oth groups showed a significant reduction of the intensity of all the gastr ointestinal symptoms evaluated, except for nausea. Conclusions IDDM patients showed a significantly lower H. pylori eradicatio n rate when compared to that observed in dyspeptic subjects. The dosage and /or the duration of a standard eradication regimen does not appear to be su fficient to eradicate the infection in IDDM patients. The impairment of the gastrointestinal mucosa microvasculature with a reduction of antibiotic ab sorption, or the frequent use of antibiotics for other infections with deve lopment of resistant strains, may be the mechanisms underlying the observat ion. Eur J Gastroenterol Hepatol 11:713-716 (C) 1999 Lippincott Williams & Wilkins.