HELICOBACTER PYLORI ASSOCIATED GLAUCOMA

Helicobacter pylori (H. pylori) is a spiral-shaped and gram-negative micro-organism that affects the epithelial mucosa of the stomach. In that site it usually causes peptic ulcer, gastritis and cancer.

Ocular manifestations of H. pylori infection include glaucoma, central serous chorioretinopathy (CSR), blepharitis, and uveitis.

It is presumed that H. pylori causes glaucoma by various mechanisms, including the release of various pro-inflammatory and vasoactive substances such as reactive oxygen species, through arteriosclerosis-induced increased platelet activation and aggregation, and impact on the trabecular meshwork cell apoptotic process.

H. pylori infection is also responsible for induction of oxidative DNA.

Cross-reactivity between antibodies to H. pylori and the ciliary epithelium and antibody-induced apoptosis has also been speculated.

Glaucoma patients have a common genetic factor that makes them more susceptible to H. pylori infection.

A meta-analysis involving 24 studies was performed to look into the probable association of H. pylori with glaucoma. Out of those 7 were cohort and 17 case-control studies. [1] 

This meta-analysis showed a statistically significant relationship between H. pylori infection and glaucoma, and further analysis showed that this positive relationship is observed in primary open-angle glaucoma (POAG), normal tension glaucoma (NTG) and pseudo-exfoliative glaucoma (PXG).

In studies by Shahram Ala et al., and also by Kountouras, H. pylori eradication treatment positively affected glaucoma management. The results showed that intraocular pressure decreased significantly after eradication treatment in the intervention group. [2] [3]

These studies suggest that this cause can be considered in certain areas where H. pylori infection is endemic.

REFERENCES:

1. Ezzati Amini E, Moradi Y. Association between helicobacter pylori infection and primary open-angle glaucoma: a systematic review and meta-analysis. BMC Ophthalmol. 2023 Sep 11;23(1):374. doi: 10.1186/s12886-023-03111-z. PMID: 37697285; PMCID: PMC10496366.

2. Ala S, Maleki I, Araghi AS, Sahebnasagh A, Shahraki A. Helicobacter pylori eradication in the management of glaucoma. Caspian J Intern Med. 2020;11(2):143.

3. Kountouras J, Mylopoulos N, Chatzopoulos D, Zavos C, Boura P, Konstas AG, Venizelos J. Eradication of Helicobacter pylori may be beneficial in the management of chronic open-angle glaucoma. Arch Intern Med. 2002;162(11):1237–44