Can H. pylori Cause Elevated LDH?
There is no direct evidence linking Helicobacter pylori infection to elevated lactate dehydrogenase (LDH) levels. The available literature does not establish H. pylori as a cause of increased LDH, even in the context of liver disease.
Evidence Review
H. pylori and Liver Disease Association
The research examining H. pylori's relationship with liver disease focuses primarily on:
Nonalcoholic fatty liver disease (NAFLD): Multiple studies show conflicting results regarding whether H. pylori increases NAFLD risk, with some demonstrating positive associations 1, 2 and others showing no relationship 3
Liver metabolic function: H. pylori infection is associated with impaired cytochrome P-450 liver metabolic activity in HCV-positive cirrhotic patients, as measured by the MEGX test, but this does not involve LDH elevation 4
Inflammatory and metabolic markers: H. pylori-positive patients show increased insulin resistance, proinflammatory cytokines (TNF-α, IL-6), C-reactive protein, and leptin/adiponectin ratio 1, 2, but LDH is not mentioned as an affected parameter
LDH in Liver Disease Context
When evaluating elevated LDH in patients with liver disease, the guidelines focus on:
LDH as a prognostic marker: Elevated LDH combined with elevated alkaline phosphatase represents an adverse prognostic factor in cancer of unknown primary 5, but this is unrelated to H. pylori infection
Alternative causes to investigate: The diagnostic approach for liver enzyme abnormalities emphasizes calculating the R value [(ALT/ULN)/(ALP/ULN)] to determine injury patterns 6, but does not include LDH as a primary hepatic marker
Clinical Interpretation
If a patient with H. pylori infection presents with elevated LDH, investigate alternative causes:
- Hemolysis: Check complete blood count, haptoglobin, indirect bilirubin, and peripheral smear
- Tissue injury: Consider myocardial infarction, pulmonary embolism, muscle injury, or malignancy
- Hematologic malignancy: Particularly lymphoma, which can cause marked LDH elevation
- Hepatocellular injury: While H. pylori may contribute to liver inflammation through metabolic and inflammatory pathways 1, 2, this would manifest primarily as elevated aminotransferases (ALT/AST) rather than LDH
Important Caveat
The absence of evidence is not evidence of absence. However, given the extensive research on H. pylori's systemic effects 1, 4, 7, 2, 3, the lack of any reported association with LDH elevation suggests this is not a clinically significant relationship. Do not attribute elevated LDH to H. pylori infection without thoroughly investigating other causes.