Evaluation of glycemic control, gastric juice nitric oxide and oxidative stress in diabetic patients infected by Helicobacter pylori

Recently, diabetes mellitus has been known as one of the main cause of upper gastrointestinal symptoms. It has also been suggested that delayed gastric emptying may lead to bacterial overgrowth in the upper gastrointestinal tract. Since high prevalence of Helicobacter pylori (H. pylori) in diabetic patients has been reported. The aim of this study was to evaluate the relationship between dyspepsia, the level of gastric juice Nitric Oxide oxidative stress and hyperglycemic control in diabetic H. pylori infected patients. Sixty H. pylori infected diabetic patients (27 males and 33 females) with mean age of 39.5 ± 12 years, 60 diabetic patients without H. pylori infection (28 males and 32 females) with mean age of 34 ± 15 years and 60 healthy individuals (28 males and 32 females) with mean age of 41 ± 8 referred to endoscopy Department were selected as Case, Control-2 and Control-1 groups respectively. All subjects underwent endoscopy. The presence of chronic active gastritis was studied in gastric mucosa and gastric biopsies were also checked with rapid urease test for presence of H. pylori. The level of NO° in gastric juice was measured calorimetrically and the activities of Superoxide Dismutase (SOD) and Glutathione Peroxidase (GPX) in gastric biopsy were determined using standard methods. The percentage of blood level of glycated Hemoglobin (HbA1C) was measured by ion exchange chromatography. Comparing with the two control groups significant elevation in the mean level of HbA1C was noticed in the case group (p<0.0001 in the both cases). The mean level of NO° in gastric juice was meaningfully higher than those in the control 1 and 2 groups (p<0.0001 in the both cases). The mean activities of SOD and GPX in the gastric mucosa were markedly higher than those of the both control groups (p<0.0001 in all cases). In patients with metabolically uncontrolled diabetes mellitus the prevalence of H. pylori infection is high and the bacteria colonization occurs at the antrum of stomach. After eradication therapy of H. pylori the control of the glyceamia will be useful. Increased levels of HbA1C in the case group in comparison with those in the uninfected subjects confirm the finding. On the other hand the treatment of the H. pylori infection improves the level of NO° in the gastric juice and reduces cellular damage resulting from acute oxidative and nitrosative stress produced by reaction between superoxide radicals of H. pylori and NO° of the gastric juice.