SARS-CoV-2 and Helicobacter Pylori: Can they Become Co-Pathogens?

Objective: SARS-CoV-2 binds to ACE (Angiotensin Converting Enzyme)-2 receptors that are expressed not only in the respiratory tract but also in the gastrointestinal tract. During Pandemia we treated more outpatients for Helicobacter pylori infection with high bacterial load. Helicobacter Pylori (HP) is known to increase the expression of ACE-2 receptors in the gastrointestinal tract.

Aim of the study to investigate: the prevalence of HP infection in pre-Pandemic (2017-2019) vs pandemic period (2020-2022); the relationship between SARS-CoV-2 and Helicobacter pylori: are they co-pathogens?

Methods: This is a preliminary retrospective study of consecutive outpatients. HP had been investigated by 13C Urea Breath test and the DOB (Delta Over Baseline). Pre- Pandemic: 179 patients. Pandemic: 137 patients. In the 137 Pandemic patients we searched for anamnestic COVID-19.

Results: The number of HP positive patients, 74 out of 137 in Pandemic, was significantly higher than that of pre- Pandemic: 36 out of 179 (p=0.000016). The DOB of pandemic was 40.4 ± 17.5, significantly higher than that of pre-pandemic: 17.4 ± 16.5 p<0.0001. Both SARS-CoV-2 and Helicobacter pylori infections were found in 5 out of 9 COVID-19 patients (55.5%). All COVID-19 affected patients, that were 12 out of 137 in Pandemic, suffered for SIBO/ Dysbiosis and Lactose intolerance/malabsorption.

Conclusion: SARS-CoV-2 enters and disrupts the GI epithelial cells through ACE-2 receptors and its Spike glycoproteins. This correlates with gastrointestinal symptoms. It also favours the entry and replication of HP into the broken cells enhancing the bacterial load. HP favours SARS-CoV-2 by increasing ACE-2 receptors. Suggestions for practitioner- To search HP also in COVID-19 current Pandemic, remembering its oncogenic properties (gastric cancer and MALT lymphoma). To put also COVID-19 in the differential diagnosis of GI diseases: COVID-19 is currently underdiagnosed.

Author(s): Giovanni Gasbarrini1*, Fabrizio Termite2, Stefano Simeoni3 and Fiorenza Bonvicini4

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