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Recent reports suggest that  Opisthorchis viverrini  serves as a reservoir of  Helicobacter  and implicate  Helicobacter  in pathogenesis of opisthorchiasis-associated cholangiocarcinoma (CCA). Here, 553 age-sex matched cases and controls, 293 and 260 positive and negative for liver fluke  O. viverrini  eggs, of residents in Northeastern Thailand were investigated for associations among infection with liver fluke,  Helicobacter  and hepatobiliary fibrosis. The prevalence of  H. pylori  infection was higher in  O. viverrini -infected than uninfected participants.  H. pylori  bacterial load correlated positively with intensity of  O. viverrini  infection, and participants with opisthorchiasis exhibited higher frequency of virulent  cag A-positive  H. pylori  than those free of fluke infection. Genotyping of  cagA  from feces of both infected and uninfected participants revealed that the AB genotype accounted for 78% and Western type 22%. Participants infected with  O. viverrini  exhibited higher prevalence of typical Western type (EPIYA ABC) and variant AB’C type (EPIYT B) CagA. Multivariate analyses among  H. pylori  virulence genes and severity of hepatobiliary disease revealed positive correlations between biliary periductal fibrosis during opisthorchiasis and CagA and CagA with CagA multimerization (CM) sequence-positive  H. pylori . These findings support the hypothesis that  H. pylori  contributes to the pathogenesis of chronic opisthorchiasis and specifically to opisthorchiasis-associated CCA.

Elevated prevalence of Helicobacter species and virulence factors in opisthorchiasis and associated hepatobiliary disease