Gastrointestinal disorder and Helicobacter pylori infection in patients with rheumatoid arthritis

Gastrointestinal disorders such as gastritis and peptic ulceration are very common in patients with rheumatoid arthritis. Helicobacter pylori appeared to be a high risk factor for the development of peptic ulcers or chronic active gastritis. Thus, the objective of this study is to elucidate gastrointestinal findings and the prevalence of H. pylori in patients with rheumatoid arthritis. Consecutive RA patients were recruited for this study, irrespective of gastrointestinal symptoms. Routine endoscopy was performed and mucosal specimens were analyzed according to the Sydney system. H. pylori infection was determined histologically using H-E staining, Wartin Starry silver staining, and immunohistochemistry. Of 97 patients, only 16 had gastrointestinal symptoms. By endoscopic examination, gastritis was observed in 39 patients (40.2%), gastric ulcers in 24 patients (24.7%), and duodenal ulcers in 7 patients (7.2%). The histological results analyzed by the Sydney system showed "inflammation," "active," and "atrophy" for 71.1%, 58.5%, and 54.6% of samples, respectively. Sixty patients (61.9%) were infected by H. pylori, but the presence of H. pylori did not increase the chance of endoscopic gastrointestinal disorders. The presence of a rheumatoid factor was inversely related to H. pylori infection, and the value of the rheumatoid factor was lower in patients with the infection. In conclusion, it was found that H. pylori infection was not a major cause of gastrointestinal disorders in RA, and that the presence of rheumatoid factor significantly reduces the chance of H. pylori infection.