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Helicobacter pylori infection and peptic ulcer disease in cirrhosis
1Department of Internal Medicine, Chi Mei Foundation Hospital, Yung Kang City, Tainan, Taiwan.
Insights
Helicobacter pylori (H. pylori) infection is common in cirrhosis patients but does not significantly correlate with peptic ulcer disease or disease severity. The link between H. pylori and peptic ulcers is weak in this population.
Area of Science:
- Gastroenterology
- Hepatology
- Infectious Diseases
Background:
- Peptic ulcer disease (PUD) is more frequent in patients with cirrhosis.
- The specific role of Helicobacter pylori (H. pylori) infection in PUD among cirrhotic patients requires further investigation.
Purpose of the Study:
- To determine the prevalence of H. pylori infection in patients with cirrhosis.
- To assess the association between H. pylori infection and peptic ulcer disease in cirrhosis.
- To evaluate the relationship between H. pylori prevalence and the severity of liver disease.
Main Methods:
- 130 patients with confirmed cirrhosis underwent upper gastrointestinal endoscopy.
- H. pylori status was determined using histology, urease testing, and serology.
- Cirrhosis severity was assessed using Child's modification of Pugh's criteria; gastropathy and varices were evaluated.
Main Results:
- H. pylori prevalence was 76.2% in the study cohort.
- No significant differences in H. pylori prevalence were observed based on cirrhosis severity (Child A, B, C), presence of congestive gastropathy, or esophageal varices.
- H. pylori prevalence did not significantly differ between cirrhotic patients with and without peptic ulcers (P = 0.09).
Conclusions:
- H. pylori infection and peptic ulcer disease prevalence are independent of cirrhosis severity.
- The association between H. pylori infection and peptic ulcer disease in patients with cirrhosis is weak.
Abstract:
An increased frequency of peptic ulcer disease is noted in patients with cirrhosis, but the role of H. pylori in this disorder remains to be determined. The diagnosis of cirrhosis was confirmed by a combination of clinical, biochemical, radiological, and histological methods. The severity of cirrhosis was assessed by Pugh's modification of Child's criteria. Upper gastrointestinal endoscopy was performed consecutively to evaluate the presence of varices and gastroduodenal mucosa. H. pylori status was assessed by histology, urease test, and serology. In all, 130 patients with cirrhosis were recruited into the study; there were 86 males and 44 females with a mean (SD) age of 54.4 (12.7) years. The H. pylori prevalence was 76.2%. There was no difference in age between the H. pylori-positive and -negative cirrhotics (P = 0.29). The H. pylori prevalence revealed no difference among cirrhotics with Child A (77.8%), Child B (72.9%), and Child C (78.6%) (P = 0.8), and neither was there a difference in H. pylori prevalence in cirrhotics with and without congestive gastropathy (77% vs 73.7%, P = 0.84). The prevalence of H. pylori in cirrhotics with and without varices did not show a statistical difference (75% vs 81.8%, P = 0.68). There also was no difference in the H. pylori prevalence between cirrhotic patients with and without peptic ulcers (84.4% vs 69.7%, P = 0.09). In conclusion, the prevalence of H. pylori or peptic ulcer is independent of the severity of cirrhotic liver disease. The association between H. pylori infection and peptic ulcer disease is weak in cirrhosis.