Prevalence of duodenal ulcer and associated Helicobacter pylori infection in chronic liver disease

Authors

  • Rajesh A. Nanda Department of Medical Gastroenterology, SRM Medical College Hospital and Research Center, Kattankulathur, Chengalpet, Tamil Nadu, India
  • Melvin George Department of Clinical Pharmacology, SRM Medical College Hospital and Research Center, Kattankulathur, Chengalpet, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20205321

Keywords:

Cirrhosis liver, Duodenal ulcer, Helicobacter pylori, UGI endoscopy, Rapid urease test, Histology

Abstract

Background: Aim was to determine the prevalence of duodenal ulcer (DU) and associated H. pylori infection in patients with liver cirrhosis.

Methods: A prospective observational study was conducted at a tertiary care medical college hospital and research center in Suburban Chennai, Southern India, where consecutive patients with cirrhosis of liver undergoing UGI endoscopy were screened for duodenal ulcer and in those with duodenal ulcer H. Pylori testing was performed with RUT and histology of antral biopsy specimen. Prevalence was compared with age and socioeconomic status matched control population who presented with dyspepsia and underwent UGI endoscopy during the study period.

Results: Total 106 patients with chronic liver disease and 481 matched non cirrhotics with dyspepsia underwent UGI endoscopy during the study.

Duodenal ulcer was diagnosed in 19.08% patients with cirrhosis and in 6.02% non-cirrhotic patients with dyspepsia.16.66% patients with DU in chronic liver disease (CLD) group were diagnosed to have H. Pylori infection by histology and RUT in comparison to 93.1% H. Pylori infection in control population with DU.

Conclusions: The incidence of DU in CLD was significantly higher when compared to general population with dyspepsia. However, majority of patients with PUD in cirrhosis of liver did not have associated H. Pylori infection. Increased incidence of DU in CLD is probably due to several other mechanisms related to portal hypertension. Routine treatment with anti H. Pylori regime may not be warranted with CLD patients with DU, therefore a test and treat strategy for H. Pylori will be more optimal in CLD.

References

Voulgaris T, Karagiannakis D, Siakavellas S, Kalogera D, Angelopoulos T, Chloupi E, et al. High prevalence of asymptomatic peptic ulcers diagnosed during screening endoscopy in patients with cirrhosis. Ann Gastroenterol. 2019;32(5):451-6.

Zullo A, Hassan C, Morini S. Helicobacter pylori infection in patients with liver cirrhosis: facts and fiction. Dig Liver Dis. 2003;35:197–205.

Fraser AG, Pounder RE, Burroughs AK. Gastric secretion and peptic ulceration in cirrhosis. J Hepatol. 1993;19:171-82.

Marshall BJ. Helicobacter pylori. Am J Gastroenterol. 1994;89(8):S116-28.

Graham DY, Sung JJ. Helicobacter pylori. In: Felman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran's gastrointestinal and liver disease. 8th ed. Philadelphia: Saunders; 2006. pp. 1049-66.

Calvet X, Navarro M, Gil M, Lafont A, Sanfeliu I, Brullet E, et al. Epidemiology of peptic ulcer disease in cirrhotic patients: role of Helicobacter pylori infection. Am J Gastroenterol. 1998;93:2501-7.

Zullo A, Rinaldi V, Meddi P, Folino S, Lauria V, Diana F, et al. Helicobacter pylori infection in dyspeptic cirrhotic patients. Hepato Gastroenterol. 1999;46:395-400.

Tsai CJ. Helicobacter pylori infection and peptic ulcer disease in cirrhosis. Dig Dis Sci. 1998;43:1219-25.

Pellicano R, Leone N, Berrutti M, Cutufia MA, Fiorentino M, Rizzetto M, et al. Helicobacter pylori seroprevalence in hepatitis C virus positive patients with cirrhosis. J Hepatol. 2000;33:648-50.

Kamalaporn P, Sobhonslidsuk A, Jatchavala J, Atisook K, Rattanasiri S, Pramoolsinsap C. Factors predisposing to peptic ulcer disease in asymptomatic cirrhotic patients. Aliment Pharmacol Ther. 2005;21:1459-65.

Ponzetto A, Pellicano R, Leone N, Berrutti M, Turrini F, Rizzetto M. Helicobacter pylori seroprevalence in cirrhotic patients with hepatitis B virus infection. Neth J Med. 2000;56:206-10.

Chen CT, Wang TF, Chan CC, Lee FY, Chang FY, Lin HC, et al. Role of chronic Helicobacter pylori infection in hyperdynamic circulation of cirrhotic patients. Hepatogastroenterology. 2002;49:208-12.

Chang CS, Kao CH, Yeh HZ, Lien HC, Chen GH, Wang SJ. Helicobacter pylori infection and gastric emptying in cirrhotic patients with symptoms of dyspepsia. Hepatogastroenterology. 1999;46:316-71.

Dore MP, Mura D, Deledda S, Maragkoudakis E, Pironti A, Realdi G. Active peptic ulcer disease in patients with hepatitis C virusrelated cirrhosis: the role of Helicobacter pylori infection and portal hypertensive gastropathy. Can J Gastroenterol. 2004;18:521-4.

Konturek SJ, Gonciarz M, Gonciarz Z, Bielanski W, Mazur W, Mularczyk A, et al. Progastrin and its products from patients with chronic viral hepatitis and liver cirrhosis. Scand J Gastroenterol. 2003;38:643-7.

Fujiwara Y, Arakawa T, Higuchi K, Kuroki T. Gastrointestinal lesions in liver cirrhosis. Nippon Rinsho. 1998;56:2387-90.

Wu CS, Lin CY, Liaw YF. Helicobacter pylori in cirrhotic patients with peptic ulcer disease: a prospective, case controlled study. Gastrointest Endosc. 1995;42:424-7.

Calvet X, Navarro M, Gil M, Mas P, Rivero E, Sanfeliu I, Brullet E, et al. Seroprevalence and epidemiology of Helicobacter pylori infection in patients with cirrhosis. J Hepatol. 1997;26:1249-54.

Siringo S, Vaira D, Menegatti M, Piscaglia F, Sofia S, Gaetani M, et al. High prevalence of Helicobacter pylori in liver cirrhosis: relationship with clinical and endoscopic features and the risk of peptic ulcer. Dig Dis Sci. 1997;42:2024-30.

Chang CS, Kao CH, Yeh HZ, Lien HC, Chen GH, Wang SJ. Helicobacter pylori infection and gastric emptying in cirrhotic patients with symptoms of dyspepsia. Hepatogastroenterology. 1999;46:3166-71.

Shahin WA, Abdel Baset EZ, Nassar AK, Atta MM, Kabil SM, Murray JA. Low incidence of Helicobacter pylori infection in patients with duodenal ulcer and chronic liver disease. Scand J Gastroenterol. 2001;36:479-84.

Auroux J, Lamarque D, Roudot Thoraval F, Deforges L, Chaumette MT, et al. Gastroduodenal ulcer and erosions are related to portal hypertensive gastropathy and recent alcohol intake in cirrhotic patients. Dig Dis Sci. 2003;48:1118-23.

Villalan R, Maroju NK, Kate V, Ananthakrishnan N. Is Helicobacter pylori eradication indicated in cirrhotic patients with peptic ulcer disease?. Tropic Gastroenterol. 2006 ;27(4):166.

Batmanabane V, Kate V, Ananthakrishnan N. Prevalence of Helicobacter pylori in patients with portal hypertensive gastropathy-a study from South India. Med Sci Monit. 2004;10:CR133-6

Bhargava N, Venkateswaran S, Ramakrishna BS, Mathan M. Colonization by Helicobacter pylori and its relationship to histological changes in the gastric mucosa in portal hypertension. J Gatroenterol Hepatol 1994;9:507-11.

Gisbert JP, Blanco M, Mateos JM, Fernandez-Salazar L, Fernandez-Bermejo M, Cantero J, et al. H. pylori-negative duodenal ulcer prevalence and causes in 774 patients. Digest Diseas Sci. 1999;44(11):2295-302.

Howden, C. Helicobacter pylori-related peptic ulcer disease: causation, diagnosis, treatment, and complications. in: E. Irvine, R. Hunt (Eds.) Evidence-based gastroenterology. BC Decker, Hamilton(Ontario). 2002:79-101

Hashizume M, Tanaka K, Inokuchi K. Morphology of gastric microcirculation in cirrhosis. Hepatology. 1983;3(6):1008-12.

Marchesini G, Zoli M, Dondi C, Bianchi G, Cirulli M, Pisi E. Anticatabolic effect of branched-chain amino acid-enriched solutions in patients with liver cirrhosis. Hepatology. 1982;2(4):420-5.

Orrego H, Kalant H, Israel Y, Blake J, Medline A, Rankin JC, et al. Effect of short‐term therapy with propylthiouracil in patients with alcoholic liver disease. Gastroenterology 1979;76(1):105‐15

Nasir N. Esophageal varices vs peptic ulcer a study of 100 patients presenting in Mayo Hospital with upper gastrointestinal bleeding. Pakistan J Gartroenterol. 1998;2:58-63.

Gado A, Ebeid B, Axon A. Prevalence and outcome of peptic ulcer bleeding in patients with liver cirrhosis. Alexand J Medic. 2014;50(2):143-8.

Grassi M, Albiani B, De Matteis A, Fontana M, Lucchetta MC, Raffa S. Prevalence of dyspepsia in liver cirrhosis: a clinical and epidemiological investigation. Minerva Med. 2001;92(1):7-12.

Kim DJ, Kim HY, Kim SJ, Hahn TH, Jang MK, Baik GH, et al. Helicobacter pylori infection and peptic ulcer disease in patients with liver cirrhosis. Korea J Inter Medic. 2008;23(1):16.

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Published

2020-11-27

How to Cite

Nanda, R. A., & George, M. (2020). Prevalence of duodenal ulcer and associated Helicobacter pylori infection in chronic liver disease. International Journal of Research in Medical Sciences, 8(12), 4442–4446. https://doi.org/10.18203/2320-6012.ijrms20205321

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Original Research Articles