Helicobacter pylori in cirrhotic patients with peptic ulcer disease: A prospective, case controlled study

Background: There is an increased prevalence of peptic ulcer disease in patients with liver cirrhosis, but the role of Helicobacter pylori is unclear. Methods: IgG antibodies against H. pylori were measured in 60 patients with compensated liver cirrhosis, in 60 sex- and age-matched patients with decompensated liver cirrhosis, and in 60 normal controls. All patients received panendoscopic examinations to search for the evidence of esophageal varices, congestive gastropathy, and peptic ulcers. Results: Duodenal ulcers were more common in compensated and decompensated cirrhotic patients (16.7% and 13.3%, respectively) than in normal controls (3.3%, p < 0.05). Gastric ulcers were more frequent in decompensated (15.0%) than compensated cirrhotic patients and normal controls (3.3% and 1.7%, respectively, p < 0.05). The prevalence of H. pylori was not statistically different among the three groups (normal 60.0%, compensated 61.7%, and decompensated, 75.0%; p > 0.05). The prevalence of H. pylori also showed no statistical differences in respect to duodenal ulceration (100%, 80%, and 87.5%, respectively, p > 0.05) or gastric ulceration (100%, 100%, and 66.7%, respectively, p ± 0.05). The prevalence of H. pylori infection did not differ significantly in relation to the presence or absence of esophageal varices or of congestive gastropathy. In cirrhotic patients with peptic ulcers, the prevalence of H. pylori was lower in the presence of esophageal varices (68.4% vs 100% if no varices, p = 0.04) and in the presence of congestive gastropathy (50.0 vs 94.7%, p = 0.03). Conclusions: The prevalence of peptic ulcer was increased in cirrhotic patients, but the prevalence of H. pylori was similar in compensated cirrhotic patients, decompensated cirrhotic patients, and normal controls. The frequency of non-H. pylori-associated peptic ulcers in cirrhotic patients was increased in the presence of esophageal varices or congestive gastropathy. (Gastrointest Endosc 1995;42:424-7.).