Effect of Helicobacter pylori infection on esophagogastric variceal bleeding in patients with liver cirrhosis and portal hypertension

Authors

  • Yoshihiro Sakamoto,

    Corresponding author
    1. Division of GI Endoscopy, Digestive Disease Center, Kurume University Hospital, Kurume, Fukuoka, Japan
    • Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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  • Kazuhiko Oho,

    1. Division of Gastroenterology, Yanagawa Hospital, Yanagawa, Fukuoka, Japan
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  • Atsushi Toyonaga,

    1. Unit of Gastroenterology and GI Endoscopy, Yasumoto Hospital, Kurume, Fukuoka, Japan
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  • Masafumi Kumamoto,

    1. Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
    2. Division of GI Endoscopy, Digestive Disease Center, Kurume University Hospital, Kurume, Fukuoka, Japan
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  • Tsuyoshi Haruta,

    1. Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
    2. Division of GI Endoscopy, Digestive Disease Center, Kurume University Hospital, Kurume, Fukuoka, Japan
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  • Hiroto Inoue,

    1. Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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  • Keigo Emori,

    1. Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
    2. Division of GI Endoscopy, Digestive Disease Center, Kurume University Hospital, Kurume, Fukuoka, Japan
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  • Osamu Tsuruta,

    1. Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
    2. Division of GI Endoscopy, Digestive Disease Center, Kurume University Hospital, Kurume, Fukuoka, Japan
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  • Michio Sata

    1. Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
    2. Division of GI Endoscopy, Digestive Disease Center, Kurume University Hospital, Kurume, Fukuoka, Japan
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Correspondence

Dr Yoshihiro Sakamoto, MD, Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Yosh 67 Asahi-machi, Kurume, Fukuoka, Japanihiro Sakamoto 830-0011, Japan. Email: yoshihirosakamoto3@gmail.com

Abstract

Background and Aims

Bleeding from esophageal and gastric varices is a fatal event in patients with liver cirrhosis and portal hypertension. However, the effects of Helicobacter pylori (H. pylori) infection on esophagogastric variceal bleeding are not known. The present study was aimed to elucidate the role of H. pylori infection in esophagogastric variceal bleeding.

Methods

The subjects were 196 cirrhotic patients who were admitted to the Kurume University Hospital to treat their esophagogastric varices consisted of 95 with acute bleeding and 101 with nonbleeding but high risk of bleeding. For the diagnosis of H. pylori infection, a 13C-urea breath test was used, and serum pepsinogen (PG) I and II levels and the PG I/II ratio were also measured.

Results

Esophagogastric variceal bleeding was seen in 34.9% (n = 30) of the H. pylori-infected patients (n = 86) and in 59.1% (n = 65) of the noninfected patients (n = 110) (P < 0.0007). There was no significant difference in the infection rate between the bleeding sites of the esophagus and the stomach. The serum PG I and II levels and the PG I/II ratio were 65.6 ng/dL, 14.7 ng/dL, and 4.4, respectively, for the bleeding patients (n = 95), and 43.7 ng/dL, 17.7 ng/dL, and 3.1 for the nonbleeding patients (n = 101). Thus, the nonbleeding patients had significantly higher rate of H. pylori infection and lower acid secretion than bleeding patients (0.001). In addition, multivariate logistic regression analysis showed a significant negative association between H. pylori infection and esophagogastric variceal bleeding.

Conclusions

These results suggest that H. pylori infection has a protective effect against esophagogastric variceal bleeding through the induction of gastric mucosal atrophy and concomitant hypoacidity.

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