Helicobacter pyloriinfection in patients with liver cirrhosis: prevalence and association with portal hypertensive gastropathy.
BACKGROUND
The role ofHelicobacter pylori(H. pylori) in the pathogenesis of portal hypertensive gastropathy (PHG) in cirrhotic patients is poorly defined. The aim of this study was toinvestigate the prevalence ofH. pyloriinfection and its association with PHG in patients with liver cirrhosis.


METHODS
Seroprevalence ofH. pyloriwas tested in 70 cirrhotic patients with PHG (cases) and 70 cirrhotic patients without PHG (controls) using an anti-H. pyloriIgG ELISA. All patients underwent upper gastrointestinal endoscopy to assess the severity of PHG and grade of varices.


RESULTS
The presence ofH. pyloriwas observed in 31 (44.3%) cirrhotic patients with PHG (cases) compared to 19 (27.1%) cirrhotic patients without PHG (controls). The risk estimate showed a significant association betweenH. pyloriand PHG in cirrhotic patients (P=0.034, OR 2.134, 95% CI 1.052-4.327). Out of the 31 patients with PHG andH. pyloriinfection, 19 had severe PHG and 12 had mild PHG while 5 patients had severe PHG and 34 had mild PHG in the group ofH. pylorinegative patients. The difference was statistically significant (P<0.001, OR 10.767, 95% CI 3.293-35.205). Of the 70 patients with PHG, 24 had severe PHG and of these 18 (75%) were in Child C compared to 6 (25%) in Child B.


CONCLUSIONS
There is significant association betweenH. pyloriinfection and PHG in cirrhotic patients which is also related to severity of PHG. Thus,H. pylorineeds to be eradicated in cirrhotic patients with PHG.
Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
Shanid Abdul
SA
Sathar
Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
Sojan George
SG
Kunnathuparambil
Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
Srijaya
S
Sreesh
Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
Premaletha
P
Narayanan
Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
Kattoor Ramakrishnan
KR
Vinayakumar
Helicobacter pylori (H. pylori); Portal hypertensive gastropathy (PHG); cirrhosis