Download PDF
CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2017; 08(03): 123-128
DOI: 10.4103/jde.JDE_34_17
Original Article
Journal of Digestive Endoscopy

Helicobacter pylori Infection in Patients with Portal Hypertensive Gastropathy Owing to Liver Cirrhosis: Prevalence and Relation with Severity of Gastropathy

Shekhar Puri
Department of Gastroenterology, SMS Medical College, Jaipur, Rajasthan, India
,
Mukesh Jain
Department of Gastroenterology, SMS Medical College, Jaipur, Rajasthan, India
,
Kumar Shwetanshu Narayan
Department of Gastroenterology, SMS Medical College, Jaipur, Rajasthan, India
,
Sudhakar Pandey
Department of Gastroenterology, SMS Medical College, Jaipur, Rajasthan, India
,
Sandeep Nijhawan
Department of Gastroenterology, SMS Medical College, Jaipur, Rajasthan, India
› Author Affiliations
Further Information

Publication History

Publication Date:
25 September 2019 (online)

Also available at
   Permissions and Reprints

ABSTRACT

Background and Aim: Helicobacter pylori is a major human pathogen. Its role in the pathogenesis of portal hypertensive gastropathy (PHG) is debated. The aim of this study was to evaluate the prevalence of this infection in patients with portal hypertension due to liver cirrhosis and its relation with severity of gastropathy. Patients and Methods: Sixty consecutive patients with liver cirrhosis were enrolled in the study. All patients were subjected to an upper gastrointestinal endoscopy (UGIE), and rapid urease testing for H. pylori was performed. The diagnosis and severity of PHG was evaluated on UGIE. ChildαTurcotteαPugh (CTP) and model for endαstage liver disease (MELD) scores were calculated to assess the severity of liver cirrhosis. Results: H. pylori infection was reported in 33 patients with overall prevalence 55%. The presence of H. pylori was observed in 26 (67%) cirrhotic patients with PHG compared to 7 (33%) cirrhotic patients without PHG. The risk estimate showed a significant association between H. pylori and PHG in cirrhotic patients (P = 0.0133, odds ratio [OR]: 4.00, 95% confidence interval [CI]: 1.298–12.325). Out of the 26 patients with PHG and H. pylori infection, 17 had severe PHG (65.3%) and 9 had mild PHG (34.6%) whereas 4 patients had severe PHG (30.8%) and 9 had mild PHG (69.2%%) in the group of H. pyloriαnegative patients. The difference was statistically significant (P = 0.04, OR: 4.25, 95% CI: 1.0188–17.729). Of the 39 patients with PHG, 21 (53.85%) had severe PHG and 18 (46.15%) had mild PHG. No significant relation was found between H. pylori infection and severity of liver cirrhosis as regards CTP score (P = 0.76) and MELD score (P = 0.56). Conclusion: Our results showed a significant association between H. pylori infection and the occurrence and also the severity of gastropathy in patients with liver cirrhosis. Yet, the severity of liver cirrhosis itself did not correlate with H. pylori or the severity of gastropathy.

KEYWORDS:

Helicobacter pylori - liver cirrhosis - portal hypertensive gastropathy
 

  • REFERENCES

  • 1 Rabinovitz M, Yoo YK, Schade RR, Dindzans VJ, Van Thiel DH, Gavaler JS. Prevalence of endoscopic findings in 510 consecutive individuals with cirrhosis evaluated prospectively. Dig Dis Sci 1990; 35: 705-10
    CrossrefPubMedGoogle Scholar
  • 2 Chung WJ. Management of portal hypertensive gastropathy and other bleeding. Clin Mol Hepatol 2014; 20: 1-5
    CrossrefPubMedGoogle Scholar
  • 3 Thuluvath PJ, Yoo HY. Portal hypertensive gastropathy. Am J Gastroenterol 2002; 97: 2973-8
    CrossrefPubMedGoogle Scholar
  • 4 Cubillas R, Rockey DC. Portal hypertensive gastropathy: A review. Liver Int 2010; 30: 1094-102
    CrossrefPubMedGoogle Scholar
  • 5 Ohta M, Yamaguchi S, Gotoh N, Tomikawa M. Pathogenesis of portal hypertensive gastropathy: A clinical and experimental review. Surgery 2002; 131 (01) Suppl S165-70
    CrossrefPubMedGoogle Scholar
  • 6 Toyonaga A, Iwao T. Portal-hypertensive gastropathy. J Gastroenterol Hepatol 1998; 13: 865-77
    CrossrefPubMedGoogle Scholar
  • 7 Sarin SK, Sreenivas DV, Lahoti D, Saraya A. Factors influencing development of portal hypertensive gastropathy in patients with portal hypertension. Gastroenterology 1992; 102: 994-9
    CrossrefPubMedGoogle Scholar
  • 8 Dore MP, Mura D, Deledda S, Maragkoudakis E, Pironti A, Realdi G. Active peptic ulcer disease in patients with hepatitis C virus-related cirrhosis: The role of Helicobacter pylori infection and portal hypertensive gastropathy. Can J Gastroenterol 2004; 18: 521-4
    CrossrefPubMedGoogle Scholar
  • 9 Patel MK, Trombly MI, Kurt-Jones EA. Innate immune responses to Helicobacter pylori infection: An overview. Methods Mol Biol 2012; 921: 205-7
    PubMedGoogle Scholar
  • 10 Al Mofleh IA. Does Helicobacter pylori affect portal hypertensive gastropathy?. Saudi J Gastroenterol 2007; 13: 95-7
    CrossrefPubMedGoogle Scholar
  • 11 Vergara M, Calvet X, Roqué M. Helicobacter pylori is a risk factor for peptic ulcer disease in cirrhotic patients. A meta-analysis. Eur J Gastroenterol Hepatol 2002; 14: 717-22
    CrossrefPubMedGoogle Scholar
  • 12 Batmanabane V, Kate V, Ananthakrishnan N. Prevalence of Helicobacter pylori in patients with portal hypertensive gastropathy – A study from South India. Med Sci Monit 2004; 10: CR133-6
    PubMedGoogle Scholar
  • 13 de Franchis R. Updating consensus in portal hypertension: Report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol 2000; 33: 846-52
    CrossrefPubMedGoogle Scholar
  • 14 Merli M, Nicolini G, Angeloni S, Gentili F, Attili AF, Riggio O. The natural history of portal hypertensive gastropathy in patients with liver cirrhosis and mild portal hypertension. Am J Gastroenterol 2004; 99: 1959-65
    CrossrefPubMedGoogle Scholar
  • 15 Fontana RJ, Sanyal AJ, Mehta S, Doherty MC, Neuschwander-Tetri BA, Everson GT. et al Portal hypertensive gastropathy in chronic hepatitis C patients with bridging fibrosis and compensated cirrhosis: Results from the HALT-C trial. Am J Gastroenterol 2006; 101: 983-92
    CrossrefPubMedGoogle Scholar
  • 16 Tarnawski AS. Microvascular abnormalities of the portal hypertensive gastric mucosa. Hepatology 1988; 8: 1488-94
    CrossrefPubMedGoogle Scholar
  • 17 Kawanaka H. Defective mitogen-activated protein kinase (ERK2) signalling in gastric mucosa of portal hypertensive rats: Potential therapeutic implications. Hepatology 2001; 34: 990-9
    CrossrefPubMedGoogle Scholar
  • 18 Pan WD, Xun RY, Chen YM. Correlations of portal hypertensive gastropathy of hepatitis B cirrhosis with other factors. Hepatobiliary Pancreat Dis Int 2002; 1: 527-31
    PubMedGoogle Scholar
  • 19 Yang DH, Huang CC, Yu JL, Song WS, Mao H, Xu C. The relationship between portal hypertensive gastropathy and Hp infection. Chin J NewGastroenterol 1997; 5: 27-8
    Google Scholar
  • 20 Balan KK, Jones AT, Roberts NB, Pearson JP, Critchley M, Jenkins SA. The effects of Helicobacter pylori colonization on gastric function and the incidence of portal hypertensive gastropathy in patients with cirrhosis of the liver. Am J Gastroenterol 1996; 91: 1400-6
    PubMedGoogle Scholar
  • 21 Arafa UA, Fujiwara Y, Higuchi K, Shiba M, Uchida T, Watanabe T. et al No additive effect between Helicobacter pylori infection and portal hypertensive gastropathy on inducible nitric oxide synthase expression in gastric mucosa of cirrhotic patients. Dig Dis Sci 2003; 48: 162-8
    CrossrefPubMedGoogle Scholar
  • 22 Abbas Z, Yakoob J, Usman MW, Shakir T, Hamid S, Jafri W. Effect of Helicobacter pylori and its virulence factors on portal hypertensive gastropathy and interleukin (IL)-8, IL-10, and tumor necrosis factor-alpha levels. Saudi J Gastroenterol 2014; 20: 120-7
    CrossrefPubMedGoogle Scholar
  • 23 Safwat E, Hussein HA, Hakim SA. Helicobacter pylori in Egyptian patients with HCV-related liver cirrhosis and portal hypertensive gastropathy: Prevalence and relation to disease severity. Life Sci J 2015; 12: 168-73
    Google Scholar
  • 24 Sathar SA, Kunnathuparambil SG, Sreesh S, Narayanan P, Vinayakumar KR. Helicobacter pylori infection in patients with liver cirrhosis: Prevalence and association with portal hypertensive gastropathy. Ann Gastroenterol 2014; 27: 48-52
    PubMedGoogle Scholar
  • 25 Urso G, Interlandi D, Puglisi M, Abate G, Bertino G, Raciti C. et al Role of Helicobacter pylori in patients with portal hypertensive gastropathy by liver cirrhosis hepatitis C virus-related. Minerva Gastroenterol Dietol 2006; 52: 303-8
    PubMedGoogle Scholar
  • 26 Parikh SS, Desai SB, Prabhu SR, Trivedi MH, Shankaran K, Bhukhanwala FA. et al Congestive gastropathy: Factors influencing development, endoscopic features, Helicobacter pylori infection, and microvessel changes. Am J Gastroenterol 1994; 89: 1036-42
    PubMedGoogle Scholar
  • 27 Kovaleva OI, Khomeriki SG, Zhukov AG, Koviazina IO, Golovanova EV. Capillary collusion of gastric mucosa in patients with Helicobacter pylori gastritis and portal hypertension. Eksp Klin Gastroenterol 2010; 2: 13-8
    Google Scholar
  • 28 Calvet X, Navarro M, Gil M, Mas P, Rivero E, Sanfeliu I. et al Seroprevalence and epidemiology of Helicobacter pylori infection in patients with cirrhosis. J Hepatol 1997; 26: 1249-54
    CrossrefPubMedGoogle Scholar
  • 29 Kim DJ, Kim HY, Kim SJ, Hahn TH, Jang MK, Baik GH. et al Helicobacter pylori infection and peptic ulcer disease in patients with liver cirrhosis. Korean J Intern Med 2008; 23: 16-21
    CrossrefPubMedGoogle Scholar
  • 30 Chen CT, Wang TF, Chan CC, Lee FY, Chang FY, Lin HC. et al Role of chronic Helicobacter pylori infection in hyperdynamic circulation of cirrhotic patients. Hepatogastroenterology 2002; 49: 208-12
    PubMedGoogle Scholar
  • 31 El-Masry S, El-Shahat M, Badra G, Aboel-Nour MF, Lotfy M. Helicobacter pylori and hepatitis C virus coinfection in Egyptian patients. J Glob Infect Dis 2010; 2: 4-9
    CrossrefPubMedGoogle Scholar