Abstract
Helicobacter pylori infection promotes gastric inflammation, but immune-response heterogeneity among infected patients remains incompletely understood. Vitamin D could function as an immune modulating factor and may play a role in modulating inflammatory balance during infection. This study assessed the correlation between vitamin D status and inflammatory immune balance as measured by IL-6, IL-10, and IL-6/IL-10 ratio in stool antigen-confirmed H. pylori patients in Baghdad, Iraq. This was a cross-sectional study from January to December 2025. A total of one hundred adult dyspeptic patients with active H. pylori infection confirmed with stool antigen testing (CK rapid kit) were recruited from private internal medicine clinics. Serum 25(OH) vitamin D was assessed by the VIDAS® system. IL-6 and IL-10 were monitored by ELISA, and IL-6/IL-10 ratio was calculated. The participants were divided into high-inflammatory (n=61) and low-inflammatory (n=39) phenotypes. SPSS 26.0 was used to analyze the statistics. Vitamin D concentrations were significantly lower in high-inflammatory patients compared with low-inflammatory patients (17.6 ± 6.5 vs 27.3 ± 8.2 ng/mL; p<0.009). They also had increased levels of IL-6, decreased IL-10, and a significantly higher IL-6/IL-10 ratio (all p<0.05)..Vitamin D deficiency (<20 ng/mL) was also significantly higher in the high-inflammatory phenotype (67.2% vs 20.5%; p<0.001). Vitamin D deficiency independently predicted the high-inflammatory phenotype (adjusted OR=5.8; p<0.001). Vitamin D deficiency is strongly associated with immune-inflammatory dominance during active H. pylori infection and may serve as a clinically relevant marker for inflammatory phenotype stratification.