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Association detected between H. pylori infection and glaucoma
If a causal link can be confirmed in the future, it may have a major impact on the management of glaucoma.
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THESSALONIKI, Greece — A recent study conducted here has found an association between Helicobacter pylori infection and glaucoma.
To determine whether H. pylori infection is associated with glaucoma, Jannis Kountouras, MD, and colleagues at the Aristotle University of Thessaloniki studied 32 patients with chronic open-angle glaucoma (COAG), nine patients with pseudoexfoliation glaucoma (PEG) and 30 age-matched anemic control patients. The results of the study were recently published in Ophthalmology.
To be included in the study, glaucoma patients required a history of intraocular pressure of 21 mm Hg or more; typical optic nerve head changes including saucerization, rim thinning or notching in the inferior or superior temporal area of the optic nerve head, or total glaucomatous cupping; and typical visual field loss including a paracentral, arcuate or Seidel’s scotoma or a nasal step. Seven of the glaucoma patients were legally blind in one eye from glaucoma.
Patients were excluded from the study if they had an eye disease other than glaucoma, diabetes mellitus or a myopic refractive error more than 8 D. All 71 study participants were between the ages of 45 and 70 years.
None of the glaucoma patients received oral medications that could decrease intraocular pressure.
Study participants in the control group had recently been diagnosed with mild iron deficiency anemia.
“The diagnosis of anemia was based on history and the gastrointestinal investigation, and none of the participants had received any treatment before the diagnosis,” Dr. Kountouras said.
Upper gastrointestinal endoscopy
Study participants were examined after a 12-hour fast. Patients were sedated intravenously, and standard upper gastrointestinal endoscopy was performed to identify evidence of macroscopic abnormalities. Three biopsy specimens were obtained from the antral region within 2 cm of the pyloric ring, and three specimens were obtained from the fundus. One biopsy specimen from each site was used for rapid urease slide testing of H. pylori infection, and the other two biopsy specimens were placed in 10% formalin and were submitted for histologic examination. The actual gold standard for the diagnosis of H. pylori infection was the detection of H. pylori organisms on microscopic analysis of mucosal biopsy specimens.
Before endoscopy, each patient had venous blood drawn for serologic testing of H. pylori IgG antibodies. At the same time, saliva samples were collected in sterile tubes for rapid urease activity. To prevent contamination of specimens taken from different sites, a fresh pair of sterile forceps was used to take the biopsy specimens from each site.
There was no difference in age or gender between the glaucoma patients and the control patients. In the glaucoma patients, the mean visual acuity was 20/30, the mean cup-to-disc ratio was 0.5, the mean defect in the visual field was 3.19 dB and the mean short-term fluctuation was 2.23 dB.
Prevalence of H. pylori
In the COAG patients, the prevalence of H. pylori infection was 87.5%, or 28 of the 32 patients. In the PEG patients, the prevalence was 88.9%, or eight of nine patients. In the control group, the prevalence was 46.7%, or 14 of 30 patients.
H. pylori was detected in the saliva in 37.5% of the COAG patients, in 55.6% of the PEG patients and in 30% of the anemic control participants. H. pylori was detected in the gastric mucosa (antrum, corpus or both) in 71.9% of the COAG patients, in 77.8% of the PEG patients and in 46.7% of the control patients.
“Histologic presence of H. pylori was observed in 87.8% of the glaucoma patients, including six of the glaucoma patients without positivity in the gastric mucosa urease test. Comparisons between the two glaucoma subgroups did not reveal any statistical difference,” Dr. Kountouras said.
In 68.3% of the glaucoma patients, increased serum levels of IgG anti-H. pylori were observed. Increased serum levels were also seen in 30% of the anemic control participants. In the COAG subgroup, increased serum levels were seen in 68.8% of patients. In the PEG subgroup, 66.7% of patients had increased serum levels.
There was endoscopic evidence of esophagitis, gastritis, duodenitis, inefficiency of lower esophageal sphincter, hiatus hernia, peptic ulcer disease or a combination noted in glaucoma and control patients. When compared with control patients, glaucoma patients had a normal endoscopic appearance of the gastric mucosa less often. Additionally, glaucoma patients more often had antral gastritis or peptic ulcer disease.
“Comparisons for endoscopic evidence of esophagitis, duodenitis, inefficiency of lower esophageal sphincter and hiatus hernia did not reveal statistical differences between glaucoma patients and anemic control participants. There was no significant difference between the two glaucoma subgroups with regard to the endoscopic findings,” Dr. Kountouras added.
For the histologic grading of H. pylori infection, all patients were graded on atrophy grade, chronicity, activity and intestinal metaplasia on a scale of 0 (absent) to 3 (high). Six of 41 glaucoma patients had grade 3 infection, while no control patients had a grade 3 infection. There was no significant difference between the groups for grade 0, 1 and 2 infections. Comparisons for the histologic grading of H. pylori infection in the two subgroups of glaucoma patients did not reveal any statistical difference.
For Your Information:Reference:
- Jannis Kountouras, MD, can be reached at 8 Phanariou Street, Byzantio, 551 33, Thessaloniki, Macedonia, Greece; (30) 31-992821; fax: (30) 31-212513; e-mail: jannis@med.auth.gr.
- Kountouras J, Mylopoulos N, et al. Relationship between Helicobacter pylori infection and glaucoma. Ophthalmology. 2001;108:599-604.