Role of <i>Helicobacter pylori</i> infection and the risk of cholelithiasis

This article aims to deepen the understanding of the role of <i>Helicobacter pylori</i> (<i>H. pylori</i>) infection in the development of cholelithiasis, initiated by the article by Yao <i>et al</i>, who investigated the potential link between <i>H. pylori</i> infection and the development of cholelithiasis through a multicenter retrospective study on an Asian population of over 70000 participants. They also performed a comprehensive analysis of previously published studies on <i>H. pylori</i> and cholelithiasis, finding a positive association therein [odds ratio (OR) = 1.103, <i>P</i> = 0.049]. Patients positive for <i>H. pylori</i> also had lower levels of total and direct bilirubin, but higher levels of total cholesterol and low-density lipoprotein cholesterol compared to uninfected patients (<i>P</i> < 0.05). Cohort studies have confirmed that <i>H. pylori</i> is a risk factor for cholelithiasis (<i>P</i> < 0.0001), and aggregate analyses of case-control and cross-sectional studies have shown a positive association between <i>H. pylori</i> and cholelithiasis in Asia (OR = 1.599, <i>P</i> = 0.034), but not in Europe (OR = 1.277, <i>P</i> = 0.246). Moreover, <i>H. pylori</i> appears to be related to a higher ratio of choledocholithiasis/cholecystolithiasis (OR = 3.321, <i>P</i> = 0.033). The authors conclude that <i>H. pylori</i> infection is positively correlated with cholelithiasis, particularly with the choledocholithiasis phenotype, especially in Asia, and it is potentially related to bilirubin and cholesterol metabolism.