Prevalence and Risk Factors of Helicobacter Pylori Recurrence in Egyptian Patients with Liver Cirrhosis

Abstract

Background: Helicobacter pylori (H. pylori) is a worldwide gastrointestinal infection. It is a common risk factor for peptic ulcer disease (PUD), chronic gastritis, and stomach cancer. In patients with cirrhosis, there is a significant association between H. pylori infection and severity of gastropathy due to portal hypertension, chronic stomach upset, frequent upper gastrointestinal bleeding as well as hepatic encephalopathy. Objective: To assess the rate and risk factors of recurrence of H. pylori infection in Egyptian patients with liver cirrhosis after successful eradication therapy. Patients and methods: This study included 500 liver cirrhosis patients who were tested for H. pylori infection. Patients with positive H. pylori infection received proton pump inhibitors (PPI)-based treatment regimen. Successful eradication therapy was assessed 4-8 weeks and repeated over one year after end of treatment using urea breath test (UBT) and stool antigen test (SAT). Results: The prevalence of H. pylori infection in cirrhotic patients was 58%. There were significantly higher serum levels of ammonia and C-reactive protein (CRP) in H. pylori positive patients as well as significantly more gastritis in endoscopy findings in comparison with H. pylori-negative patients. H. pylori recurrence after successful eradication therapy was observed in 22.1% patients of H. pylori-positive cirrhotic patients. Multivariate analysis showed that higher serum ammonia level & receiving multiple treatment courses to achieve H. pylori eradication were independent risk factors for H. pylori recurrence in cirrhotic patients. Conclusion: H. pylori infection is prevalent in liver cirrhosis patients with a significant recurrence rate after eradication therapy. High serum ammonia and the need for multiple treatment courses are risk factors for recurrence.