C-Reactive Protein Levels in Patients with Isolated Inflammatory Bowel Disease (Crohn's Disease and Ulcerative Colitis) and Coexisting H. pylori Infection and IBD: A Comparative Study.

Abstract

Introduction: The association with Helicobacter pylori infection and inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is conflicting, with the former studies reporting a protective effect while others report increased inflammation. This study examines the effect of H. pylori infection on systemic inflammation - C-reactive protein levels - among IBD patients.

Methods: This retrospective cross-sectional study was conducted at Imam Abdulrahman Bin Faisal University Hospital, Al Khobar, Saudi Arabia, by reviewing the electronic medical records of 630 patients diagnosed with H. pylori infection, CD, or UC from January 2020 to December 2024. The levels of CRP were measured with a turbidimetric immunoassay of high sensitivity and categorized as normal or less than or equal to 1 mg/dL, moderate with a value of 1-10 mg/dL, or raised if the value is above 10 mg/dL. Kruskal-Wallis and Mann-Whitney U tests were used for statistical comparisons of CRP levels between groups.

Results: Mean CRP levels were highest in H. pylori-positive CD patients (12.69 mg/dL), UC patients (11.18 mg/dL), compared to H. pylori-negative matches (6.74 mg/dL for CD and 4.55 mg/dL for UC). The H. pylori-only group had the lowest average in CRP (2.62 mg/dL). Differences in patient categories were significant (p < 0.001); CD had 50% cases with elevated CRP, 40% for UC, and 60% for moderate elevations in H. pylori-only patients.

Conclusion: H. pylori infection is also accompanied by higher systemic inflammation in IBD, specifically in CD, characterized by high CRP.