Russian Journal of Infection and ImmunityRussian Journal of Infection and ImmunityИнфекция и иммунитет2220-76192313-7398SPb RAACI151010.15789/2220-7619-HPI-1510REVIEWSОБЗОРЫHelicobacter pylori infection and inflammatory bowel diseasesИнфекция Helicobacter pylori и воспалительные заболевания кишечникаUspenskiyYu. P.УспенскийЮ. П.
Russian Federation

Uspenskiy Yu.P., PhD, MD (Medicine), Head of the Department of Faculty Therapy named after professor V.A. Valdman St. Petersburg State PMU; professor of the Department of Internal Medicine, Stomatological Faculty Pavlov First St. Petersburg SMU.

St. Petersburg

Доктор медицинских наук, заведующий кафедрой факультетской терапии им. профессора В.А. Вальдмана ФГБОУ ВО Санкт-Петербургский ГПМУ; профессор кафедры внутренних болезней стоматологического факультета ФГБОУ ВО Первый Санкт-Петербургский ГМУ им. акад. И.П. Павлова.

Санкт-Петербург

baryshnikova_nv@mail.ruBaryshnikovaN. V.БарышниковаН. В.
Russian Federation

PhD (Medicine), Associate Professor of the Department of Internal Diseases Pavlov First St. Petersburg SMU; Researcher of the Department of Molecular Microbiology IEM.

St. Petersburg

Доктор медицинских наук, заведующий кафедрой факультетской терапии им. профессора В.А. Вальдмана ФГБОУ ВО Санкт-Петербургский ГПМУ; профессор кафедры внутренних болезней стоматологического факультета ФГБОУ ВО Первый Санкт-Петербургский ГМУ им. акад. И.П. Павлова.

Санкт-Петербург

baryshnikova_nv@mail.ruSuvorovA. N.СуворовА. Н.
Russian Federation

RAS Corresponding Member, PhD, MD (Medicine), Head of the Department of Fundamental Problems of Medicine and Medical Technologies, Faculty of Stomatology and Medical Technologies St. Petersburg SU; Head of the Department of Molecular Microbiology IEM.

St. Petersburg

Доктор медицинских наук, член-корреспондент РАН, профессор, заведующий кафедрой фундаментальных проблем медицины и медицинских технологий факультета стоматологии и медицинских технологий Санкт-Петербургский ГУ; заведующий отделом молекулярной микробиологии ФГБНУ ИЭМ.

Санкт-Петербург

suvorov.an@iemspb.ruSvarvalA. V.СварвальА. В.
Russian Federation

Alena V. Svarval - PhD (Medicine), Senior Researcher, Laboratory of Pathogenes Identification.

197348, St. Petersburg, Mira str., 14, Phone: +7 (911) 223-14-11 (mobile)

Сварваль Алена Владимировна - кандидат медицинских наук, старший научный сотрудник лаборатории идентификации патогенов.

197348, Санкт-Петербург, ул. Мира, 14, Тел.: 8 (911) 223-14-11 (моб.)alenasvar@rambler.ruSt. Petersburg State Pediatric Medical UniversityФГБОУ ВО Санкт-Петербургский государственный педиатрический медицинский университетPavlov First St. Petersburg State Medical UniversityФГБОУ ВО Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова Минздрава РоссииInstitute of Experimental MedicineФГБНУ Институт экспериментальной медициныSt. Petersburg State UniversityФГБОУ ВО Санкт-Петербургский государственный университетSt. Petersburg Pasteur InstituteФБУН НИИ эпидемиологии и микробиологии им. Пастера2802202111168781506202022092020Copyright ©; 2021, Uspenskiy Y.P., Baryshnikova N.V., Suvorov A.N., Svarval A.V.Copyright ©; 2021, Успенский Ю.П., Барышникова Н.В., Суворов А.Н., Сварваль А.В.2021Uspenskiy Y.P., Baryshnikova N.V., Suvorov A.N., Svarval A.V.Успенский Ю.П., Барышникова Н.В., Суворов А.Н., Сварваль А.В.https://creativecommons.org/licenses/by/4.0https://iimmun.ru/iimm/article/view/1510

Helicobacter pylori is detected in the human intestine on average in 35% of clinical cases, but the question about its etiopathogenetic role in intestinal diseases has not been fully investigated. Many scientists study a relationship between the H. pylori persistence and development of various bowel diseases. Diverse viewpoints have been proposed regarding a potential link between H. pylori and inflammatory bowel diseases (IBD). Here we review the data from domestic and foreign studies aimed at examining potential role of H. pylori both as a trigger and protector resulting in the pathogenetic alterations leading to developing Crohn‘s disease and ulcerative colitis. The former is favored by the hypothesis wherein H. pylori may trigger IBD due to potential connection between extragastric infection and its direct damaging action as well as indirect effects contributing to the initiation of oxidative stress, autoimmune aggression and development of intestinal dysbiosis. In addition, the effects of enterohepatic Helicobacter spp. promoting IBD pathogenesis are discussed. The mechanisms underlying the protective role of H. pylori infection may be driven via differentially expressed acute and/or chronic local inflammatory mucosal response able to downmodulate systemic immune responses and suppress autoimmune reactions, as well as skewing host immune response from a pro-inflammatory Th1/Th17 cell-mediated towards regulatory T-cell response. Moreover, it was found that H. pylori may induce production of antibacterial peptides counteracting potentially pathogenic bacteria involved in IBD pathogenesis. In particular, it was found that IBD patients are dominated with moderate active antral gastritis coupled to atrophy, with the peak intensity observed in patients under 30 years of age. Intensity of intestinal metaplasia in the gastric mucosa of IBD patients accounted for by the duration of the disease course. Basal IBD therapy with 5-aminosalicylic acid lowers severity and activity of gastritis, degree of atrophy as well as magnitude H. pylori invasion in the gastric mucosa. There is evidence that 5-aminosalicylic acid-containing drugs may result in a so-called “spontaneous eradication” of H. pylori infection. Extended investigations are required to examine a role of H. pylori in IBD pathogenesis.

В кишечнике человека Helicobacter pylori выявляется в среднем в 35% случаев, однако вопрос об этиопато-генетической роли бактерии в возникновении болезней этого отдела пищеварительной трубки до конца не изучен. Предпринимаются попытки установить взаимосвязь между персистенцией H. pylori и развитием различных заболеваний кишечника. Говоря о возможной связи H. pylori и воспалительных заболеваний кишечника (ВЗК), ученые высказывают разные точки зрения. В обзорной статье представлены результаты российских и зарубежных исследований, посвященных изучению предполагаемой роли H. pylori как триггера, так и протектора в формировании патогенетических нарушений, приводящих к развитию болезни Крона и язвенного колита. В пользу гипотезы о триггерной роли H. pylori в развитии ВЗК говорит наличие возможной связи внежелудочных проявлений инфекции с прямым повреждающим действием микроорганизма и косвенными эффектами возбудителя, способствующими запуску окислительного стресса, аутоиммунной агрессии и развитию дисбиоза кишечника. Также обсуждаются вопросы влияния персистенции энтерогепатических Helicobacter spp. как промоутеров в запуске патогенеза ВЗК. Механизмами, лежащими в основе защитной роли инфекции H. pylori, могут быть дифференциальная экспрессия острого и/или хронического местного воспалительного ответа слизистой оболочки, который может снизить системные иммунные ответы и подавить аутоиммунные реакции, а также изменение иммунологического ответа хозяина от провоспалительного Th1/Th17-ответа к повышенному Т-регуляторному клеточному иммунному ответу. Кроме того, H. pylori может индуцировать продукцию антибактериальных пептидов, которые противодействуют потенциально патогенным бактериям, вовлеченным в патогенез ВЗК. Установлено, что у пациентов с ВЗК преобладает умеренно выраженный активный антральный гастрит с явлениями атрофии, наибольшая степень выраженности которой наблюдается у пациентов в возрасте до 30 лет. Степень выраженности кишечной метаплазии слизистой оболочки желудка у пациентов с ВЗК зависит от длительности клинического течения заболевания. Базисная терапия ВЗК препаратами 5-аминосалициловой кислоты снижает выраженность и активность гастрита, степень выраженности атрофии, степень инвазии слизистой оболочки желудка H. pylori. Есть данные, что препараты 5-аминосалициловой кислоты могут привести к так называемой «спонтанной эрадикации» хеликобактерной инфекции. Необходимы дальнейшие расширенные исследования по изучению роли H. pylori и его эрадикации в патогенезе ВЗК.

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