Ulcers and Pelvic Pain: A Common Role of Helicobacter pylori?
What does the stomach have in common with chronic pelvic pain? Maybe Helicobacter pylori, the bacterium that causes ulcers.
If we knew what caused chronic pelvic pain syndrome, none of this would be happening. But the reality is that in most cases the specific cause of chronic pelvic pain syndrome (CPPS), the cause is unknown. Thus, the search goes on for epidemiological clues regarding common causes.
Now comes word from researchers in Ankara that in a case-control study they have discovered evidence of exposure to Helicobacter pylori, the bacterium tha causes stomach ulcers, in men with CPPS. They speculate about its role in CPPS. Specifically:
The study focused on 64 patients with a mean age of 33 years and a mean Chronic Prostatitis Symptom Index (CPSI) score of 22 (on a scale ranging from 0 to 43). These men were compared to 55 asymptomatic controls with a mean age of 34 years and a mean CPSI score of 3.4. The two groups were not different with regard to Body Mass Index (a measure of obesity), socioeconomic status, serum prostate-specific antigen (PSA; a marker of cancer risk), and prostate volume. In addition to having very different CPSI scores, the groups differed in their urinary flow rates (the patients had slower flow), International Prostate Symptom Scores (a measure of prostatic symptoms) and sero-prevalene of H pylori: 76% for the patients and 62% for the controls.
To the best of our knowledge, this is the first demonstrated association of H pylori sero-positivity with CPPS. Accordingly, the extent to which it is generalizable is unknown. Will it reproduce in the United States? In other Turkish cohorts? Time will tell.
Could H pylori play a causal role in CPPS among Turkish men? Sure, in theory it could, if it can get into the prostate and stimulate a long-term pathological, noxious response. However, these data do not prove that this is the case. Not only do they not show bacteria in the prostate (they look only at antibodies in the serum), but they are collected in a study that is not designed to examine causality. It may be, as is common in cross-sectional epidemiological studies, that the two observations — CPPS and H pylori seropositivity — are coincidental and/or are caused by a third and as yet unidentified factor. Even if it turns out that H pylori is active in this Turkish cohort as a cause of CPPS, its overall effect of raising incidence by 16% indicates that most cases are due to other causes.
The authors have identified an association of CPPS with antibodies to the bacterium that causes stomach ulcers. The data imply absolutely no change in the current management of CPPS at the bedside. What they imply about individual risk of CPPS in Turkey specifically and globally generally is something that will have to be clarified in more research.
If we knew what caused chronic pelvic pain syndrome, none of this would be happening. But the reality is that in most cases the specific cause of chronic pelvic pain syndrome (CPPS), the cause is unknown. Thus, the search goes on for epidemiological clues regarding common causes.
Now comes word from researchers in Ankara that in a case-control study they have discovered evidence of exposure to Helicobacter pylori, the bacterium tha causes stomach ulcers, in men with CPPS. They speculate about its role in CPPS. Specifically:
The study focused on 64 patients with a mean age of 33 years and a mean Chronic Prostatitis Symptom Index (CPSI) score of 22 (on a scale ranging from 0 to 43). These men were compared to 55 asymptomatic controls with a mean age of 34 years and a mean CPSI score of 3.4. The two groups were not different with regard to Body Mass Index (a measure of obesity), socioeconomic status, serum prostate-specific antigen (PSA; a marker of cancer risk), and prostate volume. In addition to having very different CPSI scores, the groups differed in their urinary flow rates (the patients had slower flow), International Prostate Symptom Scores (a measure of prostatic symptoms) and sero-prevalene of H pylori: 76% for the patients and 62% for the controls.
To the best of our knowledge, this is the first demonstrated association of H pylori sero-positivity with CPPS. Accordingly, the extent to which it is generalizable is unknown. Will it reproduce in the United States? In other Turkish cohorts? Time will tell.
Could H pylori play a causal role in CPPS among Turkish men? Sure, in theory it could, if it can get into the prostate and stimulate a long-term pathological, noxious response. However, these data do not prove that this is the case. Not only do they not show bacteria in the prostate (they look only at antibodies in the serum), but they are collected in a study that is not designed to examine causality. It may be, as is common in cross-sectional epidemiological studies, that the two observations — CPPS and H pylori seropositivity — are coincidental and/or are caused by a third and as yet unidentified factor. Even if it turns out that H pylori is active in this Turkish cohort as a cause of CPPS, its overall effect of raising incidence by 16% indicates that most cases are due to other causes.
The authors have identified an association of CPPS with antibodies to the bacterium that causes stomach ulcers. The data imply absolutely no change in the current management of CPPS at the bedside. What they imply about individual risk of CPPS in Turkey specifically and globally generally is something that will have to be clarified in more research.
Posted by Arnon_Krongrad_MD at 8/18/2010 11:24 PM 
Categories: Infection
Tags: bacteria chronic prostatitis
Categories: Infection
Tags: bacteria chronic prostatitis
Could it be that the CPPS men had taken so many antibiotics that their stomachs immune system and lack of intestinal flora allowed H pylori to take a hold more easily?