Liver Cirrhosis and Concomitant Gastric Helicobacter Pylori Infection

Abstract

Background: Cirrhosis of liver causes a lot of morbidities and mortalities. Around one third Indians had Helicobacter Pylori (H.Pylori) infection, whose effect in disease course of cirrhosis is poorly defined. Therefore this study was undertaken with an aim to find out variable effects of Helicobacter Pylori infection in cirrhotic patients. Methods: This cross-sectional, observational, open labeled, non interventional, single centered study was carried out in the Department of Gastroenterology of Institute of Medical Sciences (I.M.S.) & SUM Hospital, Bhubaneswar in between January 2018 and December 2019. Consecutive cirrhotic cases attending the hospital were enrolled in the study, after undergoing biochemical, radiological and endoscopic evaluation. All of them also subjected to rapid urease test (RUT) to rule out Helicobacter Pylori infection. Results: Total 864 cirrhotic cases were included in this study, amongst which male outnumbered female. Mean age of presentation was 48.24±10.77 years. Alcohol was the most common etiology. Around 57.4% of cirrhosis cases had Helicobacter Pylori infection. 70.96% of alcoholic liver disease (ALD) and 50% of cryptogenic cirrhosis cases had Helicobacter Pylori infection, whereas none of chronic Hepatitis B virus (HBV) related cirrhotic had rapid urease test (RUT) positivity. Cases with Helicobacter Pylori infection presented early and had relatively higher prevalence of higher grade of Esophageal Varix, Portal hypertensive Gastropathy, Duodenal ulcer, Gastric Antral Vascular Ectasia, Gastroesophageal Varix II compared to cases without Helicobacter Pylori infection. The prognostic score such as model for end stage liver disease (MELD) was relatively higher in cases without Helicobacter Pylori infection compared to cases with Helicobacter Pylori infection. Conclusion: In our study, we found most of cirrhotic cases had alcoholic liver disease and were male. Around half of cases had Helicobacter Pylori infection and earlier presentation. Although the cases with Helicobacter Pylori infection had relatively higher endoscopic severity but had lower prognostic score compared to cases without Helicobacter Pylori infection, which should be validated in future by further studies.