Helicobacter pylori infection among patients with liver cirrhosis

Abstract

Background and aimInflammatory changes in the stomach caused by Helicobacter pylori indirectly and directly affect liver function. Moreover, the bacteria may worsen the course of the liver cirrhosis. The study aimed at evaluating the incidence of H. pylori infection among patients with liver cirrhosis, depending on the etiology and injury stage, scored according to Child–Pugh classification. Stage of esophageal varices and endoscopic inflammatory lesions in the stomach were evaluated, depending on the presence of H. pylori infection.Patients and methodsThe study included 147 patients with liver cirrhosis: 42 were infected with hepatitis C virus, 31 were infected with hepatitis B virus, 56 had alcoholic liver cirrhosis, and 18 had primary biliary cirrhosis. Diagnosis of H. pylori infection was performed based on the presence of immunoglobulin G antibodies in serum.ResultsH. pylori infection was found in 46.9% of patients. The incidence of H. pylori infection among patients with postinflammatory liver cirrhosis was significantly higher (P=0.001), as compared with patients with alcoholic liver cirrhosis. Ammonia concentration was significantly higher in patients infected with H. pylori, compared with noninfected individuals (129 vs. 112 μmol/l; P=0.002). Incidence of H. pylori infection in patients without esophageal varices was significantly lower compared with patients with esophageal varices (14 vs. 60%; P<0.001).ConclusionH. pylori infection is significantly more frequent among patients with postinflammatory liver cirrhosis (infected with hepatitis C virus or hepatitis B virus) than in patients with alcoholic liver cirrhosis or primary biliary cirrhosis. H. pylori infection correlates with elevated concentration of blood ammonia and the incidence of esophageal varices.

The Importance of H. pylori Infection in Liver Diseases

“…In the studies performed in patients with liver cirrhosis, a correlation between increasing ammonia blood concentration and H. pylori infection has been demonstrated. Moreover, ammonia blood concentration was higher among patients with liver cirrhosis infected with H. pylori, compared to patients not infected with these bacteria [37].…”

“…H. pylori infection affects increase of portal tension, which is one of the main etiologies of development of esophageal varices [6,36]. In effect, correlation between the frequency of H. pylori infection and advancement of esophageal varices is observed [37].…”

“…Although in some studies more frequent H. pylori infection among patients with liver cirrhosis cannot be confirmed [38]; however, meta-analysis was performed that included mainly patients with alcoholic liver cirrhosis, which argues for much more frequent occurrence of these bacteria among such patients. H. pylori infection is much more frequent among patients with postinflammatory liver cirrhosis (connected with HBV or HCV infection) [37]. Incidence of H. pylori infection among patients with liver cirrhosis and concomitant HCV infection increases proportionally to progressing liver failure [39].…”

“…pylori catalyzes the reaction of urea decomposition to ammonia and carbon dioxide; however, among patients with subclinical hepatic encephalopathy, infection with these bacteria does not change the concentration of ammonia in the blood [41]. These observations are inconsistent, because among patients with liver cirrhosis, especially postinflammatory cirrhosis, more frequent occurrence of symptomatic hepatic encephalopathy with hyperammonemia is observed in the case of patients infected with H. pylori, compared to patients without this infection [37,42]. In the studies performed in patients with liver cirrhosis, a correlation between increasing ammonia blood concentration and H. pylori infection has been demonstrated.…”

Association between Helicobacter pylori infection and cirrhosis in children

“…Today, the role of H. pylori infection is reported in many diseases, including idiopathic thrombocytopenic purpura [14], iron deficiency anaemia [15], and hepatic and cardiovascular symptoms and biliary tract disease [16,17]. Moreover, in some studies, the role of H. pylori in cirrhosis [18][19][20][21], hepatic encephalopathy [22,23], primary biliary cirrhosis [24], and bleeding oesophageal varices [25] is emphasised.…”