Systemic Metabolic and Inflammatory Changes Associated with Helicobacter Pylori Eradication: A Controlled Before–after Cohort Comparing Eradication Success and Persistent Infection

Ali Zeynettin; Selin Ozdemir; Sibel Bilgili; Gamze Altan

doi:10.15403/jgld-6879

Authors

Ali Zeynettin Department of Internal Medicine, İzmir City Hospital, İzmir, Türkiye
Selin Ozdemir Department of Infectious Diseases and Clinical Microbiology, İzmir Bozyaka Training and Research Hospital, İzmir, Türkiye
Sibel Bilgili Department of Medical Biochemistry, İzmir Bozyaka Training and Research Hospital, İzmir, Türkiye
Gamze Altan Department of Medical Microbiology, İzmir Bozyaka Training and Research Hospital, İzmir, Türkiye

DOI:

https://doi.org/10.15403/jgld-6879

Keywords:

Helicobacter pylori, Helicobacter pylori eradication, Insulin Resistance, high-sensitivity C-reactive protein, inflamation, metabolic dysfunction-associated steatotic liver disease

Abstract

Background and Aims: Helicobacter pylori (H. pylori) infection has been linked to systemic metabolic and inflammatory disturbances beyond the gastric mucosa, yet evidence regarding biomarker changes after eradication remains heterogeneous. This study evaluated systemic metabolic and inflammatory changes associated with eradication success versus persistent infection, using H. pylori–negative controls within a controlled before–after cohort framework.

Methods: Adults undergoing stool H. pylori antigen testing at a tertiary referral center in Türkiye (2020–2025) with paired baseline (pre) and follow-up (post) laboratory measurements were included. Participants were classified as H. pylori–negative controls, eradication success (baseline positive, follow-up negative), or eradication failure (baseline and follow-up positive). Co-primary endpoints were follow-up HOMA-IR and hsCRP (log-transformed), compared between groups using ANCOVA adjusted for baseline values and prespecified covariates. Prespecified supportive analyses used a difference-in-differences framework. Secondary outcomes included glycemic measures, lipid profile, hematological inflammation indices, and liver-related biomarkers; TyG index and FIB-4 were assessed exploratorily.

Results: A total of 3,756 individuals were included (1,321 controls; 1,847 eradication success; 588 eradication failure). In adjusted analyses, eradication success showed a more favorable follow-up profile with lower insulin resistance and systemic inflammation compared with controls, whereas eradication failure showed an opposing pattern. Directionally consistent differences were also observed across secondary metabolic, inflammatory, and hepatic biomarkers and were supported by difference-in-differences analyses.

Conclusions: Compared with H. pylori–negative controls, eradication success was associated with a more favorable systemic short-term metabolic–inflammatory profile, whereas persistent infection tended to show the opposite pattern. Prospective studies with longer follow-up are needed to determine durability and clinical relevance.