Objective: Prevalance of h. pylori infection in patients of cirrhosis of liver with its etiological correlation

Method: 100 diagnosed cases (newly and previously diagnosed cases) of chronic liver disease admitted in Medicine Department at S.N. Medical College, Agra were included in the study.  The duration of study was 18 months (during the period from June 2015 to January 2017).A thorough history, physical examination and Investigations were done, patients were categorized in different CHILD PUGH Grades and also categorized according to the different grades of esophageal varices and hepatic encephalopathy.

Result: In our study, 100 patients of chronic liver disease were enrolled, out of which 65 patients were male and 35 were female. Most of the patients were in the 41-50 years age group. The most common presenting complains of the patients in our study was ascites (62%) followed by hepatic encepahalopathy (46%) and malena (43%). Among the 100 patients, the most common cause of cirrhosis in our study was alcohol abuse (42%), followed by Hepatitis B (32%) and Hepatitis C (22%). In 4 patients, no obvious cause of cirrhosis could be identified and they were labelled as idiopathic.

Conclusion: All the patients of liver cirrhosis should be evaluated at the earliest for the presence of H pylori infection. The early detection and consequent eradication of H pylori infection may reduce the severity of complications like bleeding esophageal varices, portal gastropathy and hepatic encephalopathy.

Keywords: liver cirrhosis , H pylori, Child Pugh grade, Esophageal varices, Hepatic encephalopathy.

1. Longo, Fauci, Kasper, hauser, Jameson, Loscalzo. Harrison principles of Internal Medicine 18th edition. Chapter 308 Page 2592.
2. Rabinovitz M, Yoo YK, Schade RR, Dindzans VJ, Van Thiel DH, Gavilia JS. Prevalence of endoscopic findings in 510 consecutive individuals with cirrhosis evaluated prospectively. Dig. Dis Sc. 1990 ; 35 : 705-710.
3. Sarin SK, Sreenivas DV, Lahoti D, Saraya A. Factors influencing development of portal hypertensive gastropathy in patients with portal hypertension. Gastroenterology 1992 ; 102 : 994 - 999.
4. Lenz HJ, Hogan  DL,   Isenberg  Jl,  Intestinal  phase of gastric acid secretion     in     humans    with     and     without     portocaval     Gastroenterology. 1985; 89 : 791-796.
5. Sarfeth IJ, Tarnawski A, Mason GR, Mach T, Ivey RJ. Portal hypertension and gastric mucosal injury in rats. Gastroenterology 1983; 84:987-993.
6. Sarfeh IJ, Tarnawski A, Maeda R, Raymont K, Mason GR, Ivey KJ. The gastric mucosa in portal hypertension: effects of topical bile acid. Scand J Gastroentero M 984 ; 9(92): 189 - 194.
7. Arakawa T, Satoh H, Fukuda T, Nakamura H, Kobayashi K.Endogenous prostaglandin E2 in gastric mucosa of patients with alcoholic cirrhosis and portal hypertension. Gastroenterology 1987 ; 93 :135 - 140.
8. Hopkins RJ, Girardi LS, Turney EA. Relationship between Helicobacter pylori eradication and gastric ulcer and duodenal ulcer reduced recurrence: a review. Gastroenterology, 1996; 110: 1244 - 1252.
9. Malatya HM. Epidemiology of Helicobacter pylori infection Best Pract Res Clin Gastroenterol 2007; 21 : 205 - 214.
10. Pogorzelska J, Łapińska M, Kalinowska A, Łapiński TW, Flisiak R. Helicobacter pylori infection among patients with liver cirrhosis. European Journal of Gastroenterology & Hepatology. 2017;29 (10):1161-1165.
11. Shanid Abdul Sathar, To determine the prevalence of H. pylori infection in cirrhosis patients with PHG, to find out any association of H. pylori infection with PHG and to correlate the severity of PHG with the colonization of H. pylori. Received 6 May 2013; accepted 25 June 2013
12. Calvet X. Sanfeliu I, Musulen E et al. Evaluation of Helicobacter pylori diagnostic methods in patients with liver cirrhosis. Aliment Pharmacol. Ther. 2002; 16: 1283-1289.
13. Puri S, Jain M, Narayan KS, Pandey S, Nijhawan S. Helicobacter pylori infection in patients with portal hypertensive gastropathy owing to liver cirrhosis: Prevalence and relation with severity of gastropathy. J Dig Endosc 2017;8:123-8
14. Shanid Abdul Sathar, Sojan George Kunnathuparambil, SrijayaSreesh et al. Helicobacter pylori infection in patients with liver cirrhosis: prevalence and association with portal hypertensive gastropathy. Ann Gastroenterol 2014; 27 (1): 48-52
15. Kini D, Aggarwal R, Saraswat VA, Naik SR et al “Role of Helicobacter pylori infection in hyperammonemia and subclinical hepatic encephalopathy in cirrhosis of liver”; Indian J Gastroenterol. 2001 Nov-Dec;20(6):237-40
16. Calvet X, Navarro M, Gil M et al. Epidemiology of peptic ulcer disease in cirrhotic patients: Role of Helicobacter pylori infection. American Journal of Gastroenterology 1998 ; 93 : 2501 - 2507.
17. Săndulache L, Stanciu C et al. “Prevalence of Helicobacter pylori in liver cirrhosis complicated with hepatic encephalopathy”; Rev Med Chir Soc Med Nat Iasi. 2009 Oct-Dec;113(4):1056-60.

Dr Amit Kumar Yadav

Consultant General Medicine, District Hospital Orai Jalaun Uttar Pradesh, Uttar Pradesh, INDIA