Helicobacter Pylori Induced Interstitial Cystitis

Helicobacter-H pylori was found to have a significant role in urological diseases, prevention of bladder and prostate cancers by eradication of H-pylori infection may become a reality like what happened in the treatment of peptic ulcer disease and gastric cancer. Chronic gastritis has compelling similarities to interstitial cystitis (IC), which causes chronic bladder pain like a urinary tract infection. This is, also, known as the bladder pain syndrome (BPS). Histologically, epithelial damage, inflammatory response in the lamina propria and epithelial ulcerations are seen. It has been reported that H-pylori is relevant to several renal diseases rather than cystitis such as diabetic nephropathy, membranous nephropathy, Henoch– Schoenlein purpura nephritis, immunoglobulin A (IgA) nephropathy, etc. We present A 24 years and A 36 years ladies had chronic H-pylori in gastrointestinal tract, which is regard as common alimentary bacteria resulting into chronic infection as peptic ulcer sharing a similar pathogenesis to recurrent cystitis.


Introduction
Helicobacter pylori (H-pylori) is a gram-negative bacterium colonized in gastrointestinal tract, which is regard as common alimentary bacteria resulting into chronic infection [1]. Other than gastrointestinal diseases, the infection with H-pylori also involves cardiovascular diseases, respiratory diseases, hematological diseases, metabolic dysfunction diseases, urogenital diseases, skin diseases, etc. [2,3]. A small but interesting study did appear in the journal, Infections in Urology. Researchers found that about 87% of the patients with interstitial cystitis (IC), Trigonitis of unknown cause and/or urethral syndrome (but no bladder infection) tested positive for H-pylori, whereas only about 62% of those with diagnosed bladder infections did [4]. Interstitial cystitis is characterized by over 6 months of chronic pain, pressure and discomfort felt in the lower pelvis or bladder. It is often relieved with voiding, along with daytime frequency and nocturia in the absence of a urinary tract infection.

Case Report 1
A 36-Year-lady, known case of hypertension, hypothyroidism on Hormonal Replacement Therapy (HRT)and recurrent H. pylori infection complicated with gastric ulcer which diagnosed by OGD outside Oman ten years back. Referred to the CKD clinic, as deranged renal function and complaining of 24 months of suprapubic and pelvic pain, which is occasionally exacerbated by frequent urination, associated with intermittent gross hematuria and dysuria, no fever at any time. Many courses of antibiotic treatment were based on the patient symptoms: dysuria, pain and increased urinary frequency.
The symptoms of the patient worsened before menstruation and after sexual intercourse; finally, suprapubic pain/pressure/ discomfort related to bladder filling and an increased daytime and night-time frequency.

Informative past medical history
At the age of 10-years, patient was diagnosed as Von Willebrand disease (Heavy and long menstrual bleeding) autosomal recessive form as two of her sisters were carriers. a.
At the age of 16-yers, she underwent appendicectomy procedure.

Laboratory investigations
Urine analysis was bland, with no proteinuria (UPCR 3,6 mg/ mmol), negative for white blood cells and bacteria and urine PH was 6 (normal range <6

Medications
The patient was started on triple therapy (for eradications of H.

Laboratory Investigations
Urine analysis was clear without proteinuria (UPCR 4,2 mg/ mmol). It was also negative for white blood cells and bacteria. The urine PH was 5.0 (normal range <6). The urine cultural analysis showed no bacterial growth. CRP was in normal range (<4 mg/l).

Discussion
With >50 % of the world's population suffering from helicobacter pylori, it is one of the most prevalent human pathogens [5]. Infection with H-pylori is associated with chronic gastritis, duodenal ulcer, gastric cancer, and even gastric adenocarcinoma [6]. Other than gastrointestinal diseases, the infection with urogenital diseases, skin diseases, etc. [2,3]. Infection is usually acquired in childhood via person-to-person fecal-oral, oral-oral, or gastro-oral transmission being the most likely route of infection [7]. Unfortunately, there is no definitive diagnostic test for IC. The diagnosis is usually based upon a patient's symptoms, a cystoscopy examination of the bladder under anesthesia and exclusion of other bladder diseases [8].
Only one study specifically addressed the issue of Helicobacter Treatment options are further reduced as effective therapeutic regimen requires a combination of two or three antibiotics and a gastric acid suppressive drug [10]. Only anti H-pylori therapies that can achieve eradication rate ≥90 % are considered effective, but increasing resistance blocked the efficacy of prescribed regimens [11].
Our two cases are dramatically improved after two weeks of H-pylori triple therapy: no pelvic pain, dysuria, urinary frequency, or pain after sexual intercourse.

Conclusion
Patients with documented H-pylori may present with symptoms mimicking UTI. This association is involved in etiology of IC with inflammation of cells in the bladder wall. Treatment ameliorates the symptoms of patients dramatically after two weeks of H-pylori triple therapy.