A study was conducted among 108 lab-confirmed Covid-19 patients at a research and training hospital in Turkey from June 1 to July 20, 2020. to examine the effects of Helicobacter pylori on the clinical presentation of Covid-19 and the course of the infection. H pylori antigen was tested in stool samples to detect the presence of H. pylori. The symptoms of Covid-19, both classical and GI related were recorded. The severity of disease, duration of hospitalization, need for mechanical ventilation, outcomes, including comorbidities were also determined for the participants.

Out of the total of 108 Covid-19 patients, 31 were found to test positive for H. pylori, while 77 tested negative for H. pylori. The classical Covid symptoms of fever, dry cough, dyspnea, headache, nausea/vomiting and loss of taste/smell did not differ between the two groups. But the incidence of GI symptoms like abdominal pain (19.4% versus 2.6%) and diarrhea (32.3% versus 9.1%) was significantly higher in patients who were positive for H. pylori infection compared to those without H. pylori. No impact of H. pylori was observed on the length of hospital stay, severity of symptoms or outcome of Covid-19. No correlation between comorbid condition and H. pylori positivity was noted.

Results of this study demonstrate a robust association between the presence of H. pylori in Covid-19 patients and the symptoms of abdominal pain and diarrhea. These symptoms occurred more frequently in H. pylori-positive Covid-19 patients. It is speculated that this could be due to the large number of angiotensin-converting enzyme-2 (ACE2) receptors in the GI tract allowing entry to a large amount of the virus. H. pylori increases the expression of ACE-2 receptors in the gut resulting in more frequent occurrence of GI symptoms in Covid patients with H. pylori. The authors have called for further research to analyse the link between H. pylori and the expression of ACE-2 receptors in the respiratory system.

Balamtekin N, et al. J Pediatr Gastroenterol Nutr. 2021 Apr 1;72(4):511-513. doi: 10.1097/MPG.0000000000003005.