Active Peptic Ulcer Disease in Patients with Hepatitis C Virus-Related Cirrhosis: The Role ofHelicobacter pyloriInfection and Portal Hypertensive Gastropathy

Abstract

BACKGROUND & AIM:The relationship betweenHelicobacter pyloriinfection and peptic ulcer disease in cirrhosis remains controversial. The purpose of the present study was to investigate the role ofH pyloriinfection and portal hypertension gastropathy in the prevalence of active peptic ulcer among dyspeptic patients with compensated hepatitis C virus (HCV)-related cirrhosis.METHODS:Patients undergoing upper endoscopy with compensated HCV-related cirrhosis were enrolled. Child-Pugh's score was determined at the entry. Variceal size was measured endoscopically and the severity of portal hypertensive gastropathy was graded.H pyloriinfection status was determined by urea breath testing and/or histology.RESULTS:A total of 178 patients positive for HCV (A and B Child-Pugh's score) were prospectively included. The prevalence ofH pyloriinfection was 43%. An active peptic ulcer was found in 14 patients (8%) and was significantly more common among those withH pyloriinfection (16% versus 2% inH pyloriuninfected patients, odds ratio: 8.0). No association was observed betweenH pyloriinfection and variceal size, or hypertensive gastropathy.CONCLUSIONS:Patients with compensated cirrhosis andH pyloriinfection showed higher risk of developing a peptic ulcer. Clinical relevance of this result would be that dyspeptic patients with HCV-related cirrhosis may benefit from preventive screening and eradication ofH pylori, especially those with features of insufficient hemostasis.