Evaluation of the role of Helicobacter pylori eradication in patients with non-alcoholic fatty liver disease on non-invasive criteria for liver fibrosis including FIB_4, NFS, BARD score

Abstract

Recently, there has been a special focus on H. pylori infection as a risk factor for the development of non-alcoholic fatty liver disease (NAFLD). The aim of this study is the evaluation of the role of Helicobacter pylori eradication in patients with non-alcoholic fatty liver disease on non-invasive criteria for liver fibrosis including FIB_4, NFS, BARD score. Materials and Methods: This research was a clinical trial study. In this study, the target population was patients with non-alcoholic fatty liver who referred to the gastroenterology clinic of Imam Reza Hospital and Sheikh Al-Raees Clinic of Tabriz in 2022. The sample size was calculated to be 32 people. The sampling method was available. After giving the necessary explanations and obtaining informed consent, Helicobacter pylori fecal antigen was requested, and if the fecal antigen was positive, they were enrolled in the study and general information and fasting blood samples were taken from patients, and blood levels of albumin, CBC, fasting blood sugar, and liver enzymes ALT and AST were checked. In this study, non-invasive measures of FIB-4, NFS and BARD were also investigated. Then, Helicobacter pylori was eradicated by a regimen of four drugs including metronidazole, bismuth, amoxicillin, and pentaprazole for 2 weeks and again 6 months after treatment, the exact score of non-invasive liver criteria including FIB-4, NFS and BARD score was calculated and compared with the previous state. Results: In this study, the mean (standard deviation) of FIB-4 in the studied subjects before treatment was 1.58 (±0.6), of which 15 cases (46.9%) were in category one, and 17 cases (53.1%) were in category two. Also, the mean (SD) of FIB-4 in the studied subjects after treatment was 0.83 (±0.3), of which 31 cases (96.9%) were in category one, and one case (3.1%) was in category two. The mean (SD) of NFS in the studied subjects before treatment was -1.84 (±1.1), of which 18 cases (56.3%) were in category one, and 14 cases (43.7%) were in category two. Also, the mean (SD) of NFS in the studied subjects after treatment was -2.62 (± 1.0), of which 29 cases (90.6%) were in category one, and 3 cases (3.4%) were in category two. Based on the BARD criteria, 3 cases (9.4%) of the subjects before treatment were in category zero, 2 cases (6.3%) were in category one, 7 cases (21.9%) were in category two, 19 cases (59.4%) were in category three and one case (1.3%) was in category four. Also, based on the BARD criteria, 7 cases (21.9%) of the subjects studied after treatment were in category zero, 16 cases (50.0%) were in category one, 4 cases (12.5%) were in category two, 4 cases (12.5%) were in category three and one case (1.3%) was in category four. In this study, among the fibrosis severity criteria, all variables of FIB-4, NFS and BARD after Helicobacter pylori eradication significantly decreased compared to before Helicobacter pylori eradication in the studied subjects (P<0.001).