S2475 Helicobacter pylori and the Association With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Systematic Review of Population-Based Studies

Introduction: Helicobacter pylori is a gram-negative bacterium that damages the gastric mucosa, which allows the microbe to invade the host cells, leading to toxin release. H. pylori has a virulence factor called urease which increases survival in the highly acidic environment, leading to gut dysbiosis which reduces the bacterial diversity. This in turn leads to insulin insensitivity, increasing the susceptibility for various manifestations of metabolic syndromes, such as metabolic dysfunction associated steatotic liver disease (MASLD). The aim is to systematically review the literature of population-based studies that have evaluated the association between H. pylori infection and metabolic dysfunction. Methods: A comprehensive search of PubMed, Embase, and Scopus was conducted using PRISMA guidelines to identify population-based cross-sectional studies assessing metabolic outcomes in relation to H. pylori status. The databases searched included PubMed, Embase, and Scopus using keywords such as “H. pylori,” “metabolic syndrome,” and “MASLD”. The studies also included metabolic profiles that measured the body mass index (BMI), waist circumference, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), dyslipidemia, and hepatic steatosis. Inclusion criteria required objective diagnosis of H. pylori which included the urea breath tests, serology tests, or stool antigen tests, to assess the association with anthropometric and biochemical markers. Results: A total of 5 studies met the inclusion criteria, with sample sizes ranging from 328 to over 5,000 participants. The studies assessed whether there is a clinical correlation between H. pylori infection and poor metabolic profiles and across the studies. The average P-value was 0.03, indicating clinical significance. All of the studies demonstrated that H. pylori positive individuals had hepatic steatosis, elevated serum alanine transaminase (ALT); aspartate aminotransferase (AST), elevated low-density lipoprotein (LDL), BMI, and an enlarged waist circumference. Conclusion: Current population-based evidence indicates an association between H. pylori infection and metabolic dysfunction. These findings propose that H. pylori eradication may offer a novel adjunctive strategy in managing metabolic disorders. Further longitudinal and interventional studies are warranted to clarify causality and therapeutic impact of eradicating H. pylori to treat and prevent metabolic dysfunction.