From the Guidelines
The current evidence does not support a direct association between cholelithiasis (gallstones) and Helicobacter pylori (H. pylori) infection that would alter the management of either condition. The relationship between gallstones and H. pylori infection remains controversial, with some studies suggesting potential mechanisms by which H. pylori could contribute to gallstone formation, such as local inflammation, alteration of hepatic lipid metabolism, and changes in bile composition 1. However, these findings are not consistent across all studies, leading to insufficient evidence to recommend routine H. pyli testing or treatment for gallstone prevention or management.
Key Considerations
- The presence of gallstones is often asymptomatic, and when symptoms do occur, they typically manifest as biliary colic, which is distinct from other gastrointestinal symptoms such as those caused by H. pylori infection 1.
- The management of symptomatic gallstones primarily involves cholecystectomy, while H. pylori infection is treated with a combination of a proton pump inhibitor and antibiotics, such as amoxicillin, clarithromycin, or metronidazole, for 10-14 days 1.
- Gallbladder cancer, which is associated with gallstones, has a significant impact on mortality, but the relationship between gallstones and gallbladder cancer is not fully understood, and it is unclear if removing the gallbladder would prevent cancer in all cases 1.
Clinical Implications
- The management of gallstones and H. pylori infection should be based on current guidelines for each condition, independent of their potential association.
- Clinicians should be aware of the geographic overlap in prevalence of both conditions, which may partially explain observed associations in some populations.
- Further research is needed to fully understand the relationship between gallstones and H. pylori infection and to determine if there are any benefits to managing these conditions in a coordinated manner.
From the Research
Association between Cholelithiasis and H. pylori Infection
- The association between cholelithiasis (gallstones) and Helicobacter pylori (H. pylori) infection has been investigated in several studies 2, 3.
- A retrospective real-world cohort study of 50,832 patients found a significant association between H. pylori infection and cholelithiasis, with a hazard ratio (HR) of 1.45 (95% CI: 1.33-1.58) 2.
- A systematic review and meta-analysis of 20 studies involving 1,735 participants found a positive correlation between H. pylori infection in the gallbladder and increased risk of chronic cholecystitis and cholelithiasis, with an odds ratio (OR) of 3.05 (95% CI: 1.81-5.14) 3.
- The association between H. pylori infection and cholelithiasis was found to be stronger in men (HR: 1.63; 95% CI: 1.41-1.90) than in women (HR: 1.36; 95% CI: 1.22-1.52) 2.
Eradication Therapy and Cholelithiasis
- Eradication therapy for H. pylori infection was not associated with a reduced incidence of cholelithiasis in a large real-world cohort from Germany 2.
- Studies have investigated the efficacy of different eradication regimens for H. pylori infection, including triple-therapy regimens combining proton pump inhibitors with clarithromycin, metronidazole, or amoxicillin 4, 5.
- However, these studies did not specifically examine the association between eradication therapy and cholelithiasis.
Limitations and Future Directions
- Further studies are needed to fully understand the relationship between H. pylori infection and cholelithiasis, as well as the potential benefits of eradication therapy in preventing cholelithiasis 2, 3.
- The current evidence suggests a positive correlation between H. pylori infection and cholelithiasis, but more research is needed to confirm this association and to investigate the underlying mechanisms.