Among patients with coronavirus disease 2019 (COVID-19) who experience abdominal pain and diarrhea, there is a significant likelihood of Helicobacter pylori (H pylori) infection, according to the results of a study published in the Journal of Pediatric Gastroenterology and Nutrition.1

It is currently understood that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), binds angiotensin-converting enzyme-2 (ACE-2) receptors.2 These receptors are highly expressed in the intestine, suggesting that SARS-CoV-2 infection may lead to gastrointestinal symptoms among patients with COVID-19.

As H pylori increases ACE-2 receptor expression in the gastrointestinal tract, a group of researchers in Turkey conducted an investigation from June 1, 2020, to July 20, 2020 to determine the effects of H pylori on the clinical presentation and course of COVID-19 infections.1

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Patients who were COVID-19 positive, confirmed via polymerase chain reaction, were included in the analysis. Stool samples were collected and the presence of H pylori was determined via antigen screening tests.

A total of 108 patients (mean age, 49.54 years) were included in the analysis: 77 patients tested negative for H pylori infection and 31 patients tested positive. Compared with patients who tested negative, patients with H pylori infection had significantly more frequent abdominal pain (P =.007) and diarrhea (P =.006). However, COVID-19 severity, outcomes of the disease, and the number of hospitalized days were not significantly associated with H pylori infection.

The investigators noted that the association between H pylori infection and abdominal pain and diarrhea in patients with COVID-19 is mediated by ACE-2 receptors. “[T]here is an urgent need for studies investigating the presence of H pylori and the expression of ACE-2 receptors in the lungs and upper respiratory system,” the investigators noted.1


  1. Balamtekin N, Artuk C, Arslan M, Gülşen M. The effect of Helicobacter pylori on the presentation and clinical course of coronavirus disease 2019 infection. JPGN. 2021;72(4):511-513. doi: 10.1097/MPG.0000000000003005
  2. Lan J, Ge J, Yu J, et al. Structure of the SARS-CoV-2 spike receptor-binding domain bound to the ACE2 receptorNature. 2020;581(7807):215–220. doi. 10.1038/s41586-020-2180-5

This article originally appeared on Gastroenterology Advisor