Ulcer Bug Linked to Glaucoma

H. pylori found in majority of small study's patients

FRIDAY, June 14, 2002 (HealthDayNews) -- It's the culprit behind many a stomach ulcer, but the nasty little bacterium known as Helicobacter pylori is now being linked with a surprisingly unrelated condition -- glaucoma.

The most common form of glaucoma, primary open-angle glaucoma, is the second leading cause of blindness in the world, and is the leading cause of blindness among African-Americans.

While a variety of problems appear to bring on glaucoma, the true causes of many cases are uncertain. But researchers in Greece say they've made an important discovery: Compared to a group of patients who did not have open-angle glaucoma, those with the condition were nearly twice as likely to test positive for H. pylori.

The findings, reported in the current issue of Archives of Internal Medicine, show that H. pylori was detected in 88 percent of 41 glaucoma patients, compared to just 47 percent of a control group of 30 patients who did not have glaucoma, but were anemic.

Even more intriguing was the discovery that when the bacterium was banished with medication, the glaucoma patients showed slight improvements in their condition over the course of two years. But no improvements were seen among a handful of glaucoma patients in whom the germ was not successfully eradicated.

The improvements were reported in reduced inner eye -- or intraocular -- pressure, which usually increases with glaucoma. There were also slight improvements in visual field parameters, which deteriorate as the disease worsens.

The improvements were not substantial, but the researchers, with Aristotle University of Thessaloniki, note that since glaucoma involves a slow deterioration of vision, measures that even slow or stall the damage are important, and the possibility of actually improving the condition over time is an even greater feat.

"Although the [improvements] may not appear to be clinically significant [as opposed to statistically significant] we should bear in mind the progressive nature of glaucoma and the fact that all patients were maintained on the same regime for two years," they write.

"Longer-term follow-up is required to validate the beneficial effect of H. pylori eradication therapy," the researchers say, adding that studies of larger groups are also necessary before any findings can be confirmed.

The H. pylori germ is found in many people. The National Institute of Diabetes and Digestive and Kidney Diseases reports that about 20 percent of people under 40 years old, and half of those over age 60, have it.

Most don't experience any problems, and experts say the bacterium apparently becomes destructive only when something disrupts the balance between the germ and its host.

"Just because you have H. pylori certainly doesn't mean you're going to have, for instance, an ulcer," says Dr. Prateek Sharma, an expert on the bacterium and associate professor of medicine at the University of Kansas School of Medicine.

"Much of it has to do with a combination of host and environmental factors," he says. "Ethnicity could even play a role. In Japan, for instance, there's a high prevalence of H. pylori, as well as high ulcer disease."

Fortunately, the bacterium is usually easily controlled in ulcer patients with antibiotics and other drugs.

Whether such treatments could one day have the same impact on glaucoma remains to be seen. But even the possibility has glaucoma experts excited.

"Occasionally, someone will stumble onto a concept or correlation that will open a whole new line of thinking," says Dr. Andrew Iwach, a clinical professor of ophthalmology at the University of California, San Francisco, and a spokesman for the American Academy for Ophthalmology.

"This may be such a case, but with such a small group, it's hard to say. But it clearly merits further study to see if the results are repeated in a larger group."

Open-angle glaucoma affects about 3 million Americans. The condition causes the eyes' drainage canals to become clogged over time, resulting in a buildup of inner-eye pressure.

If left untreated, the condition can cause a gradual loss of vision, but early detection isn't easy because there are usually no symptoms.

If caught early enough, however, there are effective options for treatment, including eye drops, laser treatments, and even surgery.

"The key element is early detection," Iwach stresses. "The earlier we can catch this disease, the better the odds are to help the patient maintain useful vision."

What To Do

The American Academy of Ophthalmology offers extensive information on glaucoma. And visit the National Institute of Diabetes and Digestive and Kidney Diseases for more information on H. pylori.

SOURCES: Prateek Sharma, M.D., associate professor of medicine at the University of Kansas School of Medicine, Kansas City; Andrew Iwach, M.D., clinical professor of ophthalmology at the University of California, San Francisco and spokesman for the American Academy for Ophthalmology; June 10, 2002, Archives of Internal Medicine
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