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Helicobacter pylori as an Initiating Factor of Complications in Patients With Cirrhosis: A Single-Center
Ahmed Abdel-Razik1, Nasser Mousa1, Rania Elhelaly2
1Tropical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Insights
Helicobacter pylori infection is linked to increased risks of liver cirrhosis complications like portal vein thrombosis and hepatocellular carcinoma. Eradicating H. pylori may reduce these risks and improve patient outcomes.
Area of Science:
- Gastroenterology and Hepatology
- Infectious Diseases
- Oncology
Background:
- The association between liver cirrhosis and Helicobacter pylori (H. pylori) infection remains debated.
- H. pylori infection may influence the progression and complications of liver disease.
Purpose of the Study:
- To investigate the potential link between H. pylori infection and liver cirrhosis.
- To evaluate the impact of H. pylori eradication on cirrhosis-related complications.
Main Methods:
- A prospective cohort study followed 558 cirrhosis patients for one year.
- Serum inflammatory markers (CRP, TNF-α, IL-6, NO, VEGF) and fecal H. pylori antigen were measured.
- H. pylori-positive patients received treatment and were followed for outcomes.
Main Results:
- 48.4% of patients had H. pylori infection, associated with elevated inflammatory markers and increased incidence of varices, gastropathy, HCC, SBP, encephalopathy, PVT, and HRS.
- H. pylori presence was an independent risk factor for PVT and HCC.
- H. pylori eradication led to significant reductions in inflammatory markers and complications.
Conclusions:
- H. pylori infection exacerbates liver cirrhosis complications, including PVT and HCC, via inflammatory and vascular pathways.
- Eradication of H. pylori infection shows potential in mitigating these adverse outcomes.
Abstract:
Background and Aim: The relationship between liver cirrhosis and Helicobacter pylori (H. pylori) is a debatable matter. The aim of this study is to evaluate the possible association between H. pylori infection and liver cirrhosis. Methods: A single-center prospective cohort pilot study of 558 patients with cirrhosis was followed up for 1 year. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), nitric oxide (NO), vascular endothelial growth factor (VEGF) levels and Fecal H. pylori antigen were evaluated by enzyme-linked immunosorbent assay (ELISA). All patients with positive H. pylori were treated and then followed up for 3 months. Participants with eradicated H. pylori were followed up for one further year. Results: H. pylori-positive patients (48.4%) were associated with increased levels of serum CRP, TNF-α, IL-6, NO, and VEGF, as well as increased incidence of varices, portal hypertensive gastropathy, gastric antral vascular ectasia, hepatocellular carcinoma (HCC), spontaneous bacterial peritonitis, hepatic encephalopathy, portal vein thrombosis (PVT), and hepatorenal syndrome (all P < 0.05). Multivariate analysis models revealed that the presence of H. pylori was an independent risk variable for the development of portal vein thrombosis and hepatocellular carcinoma (P = 0.043, P = 0.037) respectively. After treatment of H. pylori infection, there was a significant reduction in all measured biochemical parameters and reported cirrhotic complications (all P < 0.05). Conclusion: Incidence of PVT and HCC development increased with H. pylori infection through increased inflammatory markers and vascular mediators. Moreover, its eradication may reduce the incidence of these complications.
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