Association of Helicobacter pylori infection with somatostatin deficiency and its relation to post-endoscopic retrograde cholangiopancreatography pancreatitis

Abstract

Background Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). It can be diagnosed clinically in patients complaining of severe abdominal pain with rising of serum amylase and lipase more than three-folds of high normal levels within 24 h of the procedure. Aim The aim of this work was to determine if there is an association between Helicobacter pylori infection and low somatostatin level and its relation to PEP. Patients and methods A total of 80 patients with obstructive jaundice requiring ERCP were enrolled in this study and were, divided according to H. pylori infection into the following: 37 H. pylori positive patients (group A) and 43 H. pylori negative patients (group B). All patients were subjected to full history taking; clinical examination, serum bilirubin, serum amylase and serum lipase just before and 24 h after ERCP; histological examination of gastric biopsies to detect H. pylori and serum somatostatin level with follow-up for 24 h for any symptom or signs suggestive of PEP. Results The percentage of PEP was 10.8% in group A and 9.3% in group B, with an overall percentage of 10%. Patients who experienced PEP had a statistically significant lower somatostatin level than patients who did not experience PEP. Significant increase in somatostatin level was registered in H. pylori-infected patients. Certain ERCP-related maneuvers, such as difficult ampullary cannulation, repeated pancreatic duct cannulation and precut sphincterotomy, carry the risk of PEP. Conclusion No association between H. pylori infection and PEP was seen. Low somatostatin level can be useful in prediction of PEP.

Keywords

• endoscopic retrograde cholangiopancreatography
• helicobacter pylori
• somatostatin