Epidemiology of peptic ulcer disease in cirrhotic patients: role of helicobacter pylori infection

Calvet, Xavier; Navarro, María Pleguezuelo; Gil, Montserrat; Lafont, A; Sanfeliú, Isabel; Brullet, Enric; Campo, Rafel; Dalmau, Blai; Rivero, Elena Riet Correa; Mas, P

doi:10.1111/j.1572-0241.1998.00711.x

Cited by 45 publications

(24 citation statements)

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“…The morbidity and mortality of ulcer complications have been shown to be very high in these patients. Helicobacter pylori infection is the major cause of peptic ulcer in cirrhosis, as it is in the general population 1–3 . The eradication of H. pylori infection in ulcer patients leads to nearly total prevention of subsequent peptic ulcer and its complications 4–7 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Helicobacter pylori diagnostic methods in patients with liver cirrhosis

Calvet

Sanfeliú

Musulén³

et al. 2002

Aliment Pharmacol Ther

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SUMMARYBackground: Helicobacter pylori-associated peptic ulcer is a frequent complication in cirrhotic patients and its morbidity rate is high. In spite of this, diagnostic methods for H. pylori infection have not been fully evaluated in these patients. Aim: To evaluate H. pylori diagnostic methods in patients with liver cirrhosis. Methods: One hundred and one cirrhotic patients were included in the study. Three antral and two corpus biopsies were obtained for rapid urease test of the antral mucosa, and Giemsa stain and immunohistochemistry were performed for both the corpus and antrum.

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Section: Introductionmentioning

confidence: 99%

Evaluation of Helicobacter pylori diagnostic methods in patients with liver cirrhosis

Calvet

Sanfeliú

Musulén³

et al. 2002

Aliment Pharmacol Ther

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“…Furthermore, both acid-related diseases and H. pylori infection increase with aging (8,9), and elderly patients are often on multiple medications for comorbid conditions, thus increasing the potential for drug-drug interactions (10,11). In addition, patients with liver disease also have a high prevalence of H. pylori infection (12), and the choice of PPIs in patients with decreased liver metabolic function due to the underlying disease can be particularly important (13)(14)(15)(16)(17). Finally, also antimicrobial agents used in H. pylori eradication therapy can interfere with liver metabolic function (18,19).…”

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confidence: 98%

Influence of 1-Week Helicobacter pylori Eradication Therapy with Rabeprazole, Clarithromycin, and Metronidazole on 13C-Aminopyrine Breath Test

et al. 2005

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Helicobacter pylori eradication therapy is commonly prescribed in the general population. Treatment consists of drugs that are mainly metabolized by the liver cytochrome P-450 (CYP) enzymatic pool. Most H. pylori-infected patients often take drugs for comorbid illnesses, therefore increasing the potential for drug-drug interactions. We aimed to evaluate the interactions of rabeprazole, clarithromycin, and metronidazole 1-week H. pylori eradication therapy with CYP-dependent liver metabolic function in clinical practice. Ten patients referred to our unit for H. pylori infection underwent 1-week eradication therapy with rabeprazole (20 mg, b.i.d.), clarithromycin (500 mg, b.i.d.), and metronidazole (500 mg, b.i.d.). We chose the 13C-aminopyrine breath test (13C-ABT) to evaluate CYP-dependent liver function since it is noninvasive and nonharmful. All patients underwent 13C-ABT at three time points: before therapy (to), at the end of therapy (t8), and after 1 month of follow-up (t38). Mean 13C-ABT dose/hr (t0 = 14.0 +/- 5.4, t8 = 13.5 +/- 4.0, t38 = 16.1 +/- 5.6) as well as 13C-ABT cumulative dose (t0 = 2.4 +/- 1.1, t8 = 2.4 +/- 0.8, t38 = 2.6 +/- 1.0) were not statistically different at the three time points of the study. These results did not seem to be influenced by drugs being administered concomitantly. In everyday clinical practice rabeprazole-based H. pylori eradication therapy does not seem to display any significant interactions with CYP-dependent liver function, even in patients on multiple drugs.

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“… 31 Furthermore, many of these studies took into consideration the influence of H. pylori infection on the presence of peptic ulcer disease, oesophageal varices and hypertensive gastropathy 9–11 , . 13 , 14 , 31 , 32 Results have shown no evidence that H. pylori infection affects the presence and severity of liver disease‐related events, although it seems that it might play a role in a subset of patients with hepatic encephalopathy 12 , . 33 Overall, these and other studies have shown no association between gastric H. pylori infection and the severity of liver disease as assessed by means of the Child–Pugh score.…”

Section: Discussionmentioning

confidence: 99%

“…In cirrhotic patients, H. pylori infection has shown no correlation with the severity of liver disease, as assessed by the Child–Pugh score and by portal hypertension‐related features, although contrasting results have been obtained with regard to hepatic encephalopathy 9–14 . However, because the occurrence of systemic infections, as well as the increased permeability of the gut wall to bacterial antigens, in cirrhotic patients is associated with a decrease in liver function, probably mediated by pro‐inflammatory cytokines, 15–19 we deemed it of interest to evaluate whether H. pylori infection may influence liver function in patients with cirrhosis of the liver.…”

Section: Introductionmentioning

confidence: 99%

Impairment of cytochrome P‐450‐dependent liver activity in cirrhotic patients with Helicobacter pylori infection

Giannini

Fasoli

Borro

et al. 2001

Aliment Pharmacol Ther

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Background: Helicobacter pylori gastric infection has been associated with various digestive and extra‐digestive diseases. The systemic influence of gastric H. pylori infection seems to be mediated by the release of various cytokines. In liver disease, bacterial infections have been associated with the impairment of liver metabolic function. Aims: To evaluate the influence of H. pylori infection on liver function as assessed by means of the monoethylglycinexylidide test, which depends upon liver blood flow and cytochrome P‐450 activity, and the 13C‐galactose breath test, which depends on cytosolic enzymatic activity and is correlated with hepatic functional mass. Moreover, to evaluate whether H. pylori‐associated modifications of liver function may be related to tumour necrosis factor‐α serum levels. Patients and methods: Thirty‐five patients with liver cirrhosis of various aetiologies, who underwent monoethylglycinexylidide and 13C‐galactose breath tests, were retrospectively evaluated for H. pylori infection by means of anti‐H. pylori immunoglobulin G. The main clinical, biochemical and functional characteristics of the patients as well as their tumour necrosis factor‐α serum levels were then analysed on the basis of the presence of H. pylori infection. Results: Twenty‐one patients tested positive for H. pylori infection (60%), and 11 tested negative (31.4%). No clinical or biochemical differences were observed between H. pylori‐infected and non‐infected patients. H. pylori infection showed no difference in distribution according to Child–Pugh classes (A, 55%; B and C, 67%). The monoethylglycinexylidide test results were significantly lower at each sampling time in H. pylori‐positive patients compared to H. pylori‐negative patients (MEGX15, P=0.027; MEGX30, P=0.014; MEGX60, P=0.028), while 13C‐galactose breath test showed no significant differences considering both cumulative percentage dose and percentage dose/h. The median tumour necrosis factor‐α serum levels were no different between H. pylori‐positive (16.1 pg/mL, 95% confidence interval, 8.7–28.7) and H. pylori‐negative (12.3 pg/mL, 95% confidence interval, 8.7–23.4) patients. Conclusions: In cirrhotic patients, H. pylori infection seems to selectively affect cytochrome P‐450 liver activity, while hepatic functional mass does not seem to be impaired. Tumour necrosis factor‐α does not seem to be the mediator of this impairment. Further studies are needed to evaluate the impact of H. pylori eradication on parameters of liver function.

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Epidemiology of peptic ulcer disease in cirrhotic patients: role of helicobacter pylori infection

Abstract: Male sex and seropositivity for Helicobacter pylori are the major risk factors for peptic ulcer in cirrhosis.

Cited by 45 publications

References 44 publications

Evaluation of Helicobacter pylori diagnostic methods in patients with liver cirrhosis

Evaluation of Helicobacter pylori diagnostic methods in patients with liver cirrhosis

Influence of 1-Week Helicobacter pylori Eradication Therapy with Rabeprazole, Clarithromycin, and Metronidazole on 13C-Aminopyrine Breath Test

Impairment of cytochrome P‐450‐dependent liver activity in cirrhotic patients with Helicobacter pylori infection

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