Open AccessIs There an Association between Variceal Bleed and Helicobacter pylori Infection in Cirrhotic Patients with Portal Hypertension?
Author(s) -
Sathyanarayan Varuna,
Sathasivam Sureshkumar,
Balakrishnan Gurushankari,
Elangovan Archana,
Subair Mohsina,
Vikram Kate,
Balasubramanian Vairappan,
Mahalakshmy Thulasingam
Publication year - 2022
Publication title -
sultan qaboos university medical journal
Language(s) - English
Resource type - Journals
eISSN - 2075-0528
pISSN - 2075-051X
DOI - 10.18295/squmj.9.2021.136
Subject(s) - medicine , gastroenterology , cirrhosis , portal hypertension , helicobacter pylori , varices , liver disease , prospective cohort study , gastric varices , incidence (geometry) , hepatic encephalopathy , bleed , surgery , physics , optics
Objectives: The objective of this study was to find the association of H. pylori in patients with variceal bleeding as well as rebleeding in cases of cirrhosis with portal hypertension. Methods: This was a prospective cohort of patients with bleeding esophageal varices. The primary outcome was correlation between prevalence of H. pylori and the incidence of bleeding/ rebleeding from varices and with encephalopathy. The secondary outcome were correlation between the site of bleeding with H. pylori infection and the association of pepsinogen I & II and the ratio of pepsinogen I/II with bleeding. Results: A total of 190 patients were assessed for eligibility, out of which 159 patients were included in this study. 124 out of 159 patients (77.9%) had alcohol-related liver disease. 8 out of 159 patients had HBV-related liver disease. 7 patients with varices had neither bled at presentation nor did bleed in the follow-up period. A total of 78 out of 159 (49.05%) patients were H.pylori-infected. Patients with esophageal varices [Adjusted Risk (AR)=0.7] and H.pylori infection (AR=0.7) had a lower risk of variceal rebleeding. Among the patients negative for H.pylori, pepsinogen I was higher in patients with rebleeding (30.7 vs 14.4; p<0.001). Among H.pylori positive patients, the ratio of pepsinogen I/II was higher in patients with rebleeding (2.9 vs 1.3; p=0.023). Conclusion: H.pylori infection was associated with a lower risk of rebleeding in cases of cirrhosis with portal hypertension. Irrespective of the status of H.pylori infection, rebleeding was associated with more gastric acid output demonstrated by the level of pepsinogen.
Keywords: Pepsinogen; hepatic encephalopathy; gastric acid output, Helicobacter pylori