Helicobacter pylori Infection in Cirrhotic Patients With Portal Hypertensive Gastropathy: A New Enigma?

Abstract

The relationship between Helicobacter pylori (H. pylori) infection and Portal hypertensive gastropathy (PHG) is still a debatable matter. The aim of this study is to find out how common H. pylori infection is in cirrhotic patients with PHG and to see if there’s a link between H. pylori infection and PHG severity. Out of 340 cirrhotic patients who had upper Gastrointestinal Tract (GIT) endoscopy for early varices screening, 160 cirrhotic patients were selected and divided into 2 groups; 80 cirrhotic patients with PHG (cases) and 80 cirrhotic patients without PHG (controls). Gastric biopsies were taken from all enrolled patients for histological evaluation for the presence or absence of H. pylori infection. H. pylori was found in 44 cirrhotic patients (55%) who had PHG (cases), compared to 22 cirrhotic patients (27.5%) who did not have PHG (controls). The prevalence of H. pylori infection was significantly higher in patients with PHG (p < 0.001). The severity of PHG was associated with H. pylori infection (p < 0.001). The response to eradication therapy of H. pylori infection was must better in patients without PHG (p = 0.045). By multi-variant analysis, H. pylori infection, splenic diameter, and portal vein diameter were independent predictors for PHG presence. After treating H. pylori infection in patients who tested positive for H. pylori, there was a significant reduction in PHG severity (p < 0.001). Patients with PHG have a greater prevalence of H. pylori infection. PHG is more severe in patients infected with H. pylori. To improve PHG severity, cirrhotic patients must have their H. pylori infection eradicated.

The Association of Helicobacter pylori With Portal Hypertensive Gastropathy in Patients With and Without Cirrhosis

“…Portal hypertension produces changes in gastric mucosa, including alteration in vascular caliber, structure, and amount of blood flow. Helicobacter pylori , on the other hand, also alters gastric and duodenal microcirculation [ 5 , 9 ].…”

“…Numerous studies have shown an increased prevalence of H. pylori in portal hypertensive gastropathy; however, the true mechanism for this higher prevalence remains obscure, with different studies postulating different mechanisms. One of the popular theories is that H. pylori causes hypoxic mucosal surface and diminished epithelial integrity, which may facilitate colonization with this organism, while others claim that mucosal swelling and congestion, which increase nitric oxide, act as a suitable media for the growth of H. pylori [ 5 - 7 , 10 ]. Still, another famous theory is that in PHG, there is mucosal thinning and higher pH with decreased prostaglandin levels, facilitating H. pylori .…”

“…This suggests the plausible role of H. pylori in the pathogenesis of PHG. Others have reported the effect of H. pylori on the severity of PHG by postulating that both liver cirrhosis and PHG are more severe in those with this infection as compared to those without it [ 5 , 12 ].…”

“…Endoscopy post-eradication showed significant improvement in PHG (p=0.045). However, there are various limitations of this study, as it neither elaborates on the time frame after the eradication of H. pylori , after which endoscopy was repeated, nor mentions whether patients received any other treatment for liver cirrhosis or PHG in the interim [ 5 ].…”

“…One of the dreaded complications of H. pylori infection is gastric cancer, especially adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphomas. However, there is a controversy regarding its relationship with PHG in patients with liver cirrhosis [4][5][6][7]. Understanding the frequency of H. pylori infection in patients with liver cirrhosis and its association with PHG can be helpful in comprehending its probable involvement [3].…”