Relationship Between Helicobacter Pylori And Non-alcoholic Fatty Liver Disease And Related Colorectal Polyps

Objectives:Non-alcoholic fatty liver disease(NAFLD)has been the most common cause of chronic liver disease around the world.At present,there is no specific therapeutic drug for NAFLD,leading to an increasing clinical burden.Studies have shown that Helicobacter pylori(H.pylori)infection is associated with the occurrence and development of NAFLD,but there is still controversy.To investigate whether H.pylori infection exacerbates the severity of non-alcoholic fatty liver disease(NAFLD)and metabolic indicators such as serum glucose,lipid and blood pressure,and to assess the risk of severe colorectal polyps in NAFLD patients complicated with H.pylori infection,may provide new prevention and treatment methods for NAFLD and related CRA.Methods:The data of 118 patients diagnosed as NAFLD by abdominal ultrasound in the second Affiliated Hospital of Kunming Medical University from December 2018 to May 2020 were collected.They were divided into two groups according to the test results of H.pylori,namely NAFLD with H.pylori group and NAFLD without H.pylori group.The severity of liver steatosis and liver stiffness of NAFLD patients were divided into mild,moderate and severe according to the FibroTouch test results.The differences of severity of liver steatosis and liver stiffness,liver function tests,serum lipid,serum glucose,inflammatory indicators and MetS related diseases(hypertension,diabetes,hyperlipidemia)were compared between the two groups.The location,size,number,pathology(proliferative polyps/gut adenomas)and intraepithelial neoplasia of colorectal polyps in the two groups were compared,and the relationship between H.pylori infection and colorectal polyps severity of NAFLD patients was analyzed.Results:A total of 118 NAFLD patients were enrolled,of which 62 were H.pylori positive(NAFLD with H.pylori group),and 56 were H.pylori negative(NAFLD without H.pylori group).There were more patients with moderate and severe liver steatosis degree(x2=12.850,P<0.01)and liver stiffness degree(x2=13.390,P<0.01)in the positive group than in the negative group.The BMI,CAP,E score,ALT,AST,GGT,TBIL,DBIL,TC,TG,LDL,TyG,WBC,PCT,IL-6,CRP,NLR,APRI score and NFS score in NAFLD with H.pylori group were higher than that in NAFLD without H.pylori group(P<0.05).And the H.pylori positive group were more likely to be associated with hypertension and diabetes(P<0.05).A total of 75 patients(37 H.pylori positive and 38 H.pylori negative)performed colonoscopy.The incidence of multiple polyps,polyps ≥ 1 cm in diameter,adenomatous polyps and polyps combined with intraepithelial neoplasia in the NAFLD with H.pylori group was higher than that in the NAFLD without H.pylori group(P<0.05).Multivariate logistic regression analysis showed that positive H.pylori was an influencing factor for the number of colorectal polyps(OR=7.547,95%CI(1.467,38.827)),polyps pathology[OR=8.500,95%CI(1.574,45.916)],and polyps combined with intraepithelial neoplasia(OR=4.571,95%CI(1.218,17.157))in NAFLD patients(P<0.05).Conclusions:H.pylori infection can aggravate BMI,hypertension,diabetes,liver dysfunction,dyslipidemia,inflammatory response,liver fibrosis,and liver steatosis in NAFLD patients.In addition,H.pylori infection may increase the risk of severe colorectal polyps in NAFLD patients.