Association Between Active Helicobacter pylori Infection and Fecal Calprotectin Categories: A Cross-Sectional Analytical Study in an Iraqi Clinical Population
Helicobacter pylori; fecal calprotectin; intestinal inflammation; C-reactive protein; white blood cell count; fecal occult blood.
AuthorsAbstractBackground: Helicobacter pylori mainly involves the gastric mucosa; however, its connection to fecal calprotectin (FC), an indicator of neutrophilic inflammation in the gastrointestinal tract, is not fully known yet. In the present study, the correlation between H. pylori infection and FC categories was determined together with inflammatory, hematologic, nutritional, and stool characteristics of the patients. Methods:. The present cross-sectional study consisted of 429 subjects aged 4-88 years visiting the Al-Nokhba Private Laboratory, Iraq, due to digestive symptoms or with a clinical suspicion of active infection with H. pylori from May 2025 to May 2026. H. pylori stool antigen test and 13C-urea breath test were used for active infection with H. pylori. FC values were classified as normal (≤50 µg/g), intermediate (51-250 µg/g), and high (>250 µg/g). CRP, ESR, WBC count, platelets count, hemoglobin, ferritin, zinc, vitamin B12, HbA1c, FOB, red blood cells in stool, and pus cells in stool were investigated. The comparisons of continuous variables were made by the Kruskal–Wallis test, whereas the analysis of categorical variables was performed by Pearson’s chi-square test or Fisher’s exact test, depending on the nature of the data. Cochran-Armitage trend test was used to evaluate the trend in H. pylori positivity among FC groups. Results: Of the 429 subjects studied, 279 (65.0%) subjects tested positive for H. pylori infection. Normal, intermediate and high FC levels were observed in 255 (59.4%), 100 (23.3%), and 74 (17.2%) participants respectively, meaning that 174 subjects (40.6%) had FC levels higher than 50 µg/g. The prevalence of H. pylori infection ranged from 48.6% in the normal-FC group to 81.0% in the intermediate FC group and 100% in the high FC group (p<0.001; p for trend < 0.001). There were significant differences in CRP levels and WBC count among the FC groups (p=0.001 and p=0.002, respectively). However, there were no significant differences between the groups in ESR, platelet count, hemoglobin and ferritin level. The same was observed for zinc concentrations (p = 0.003). There were no significant differences in vitamin B12 and HbA1c levels. FOB positivity increased from 3.9% in the normal-FC group Conclusion: FCs in higher categories correlated with increasing H. pylori positivity and were also characterized by increased levels of CRP, WBC, and FOB positivity. However, since this result is obtained through an unadjusted cross-sectional analysis, it cannot be concluded that H. pylori infection causes increased FC. An elevated level of FC, especially combined with FOB positivity, needs further assessment for other inflammatory and anatomical diseases of the digestive system. In order to elucidate the nature of this correlation, a prospective multicenter study with the use of endoscopic and histological examination and FC testing both before and after treatment is needed. •••••••••••••••••••••••••••••••• ejprd.org - Published by Riset Publication Services LLC
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