Low incidence of Helicobacter pylori infection in patients with duodenal ulcer and chronic liver disease. Scand J Gastroenterol 2001;36:479-484.Background: Duodenal ulcer (DU) is a common problem in patients with chronic liver disease (CLD) and with inadequate response to H2 receptor antagonists. Omeprazole might be more effective. In DU-CLD patients, Helicobacter pylori prevalence is low. Nitric oxide is increased in gastric mucosa in cirrhosis. Oxygen-free radicals have a role in gastric in ammation and are abnormal in CLD. Nitrotyrosine is a marker of nitric oxide and oxygen-free radical toxic mucosal reaction. Methods: Sixtynine patients were divided into 2 groups: control (26 patients with DU) and CLD groups (43 patients, DU-CLD). Omeprazole was given (40 mg/day) for 2 or 4 weeks. Symptoms and endoscopy ndings were recorded before and after treatment. Antral biopsy specimens were stained for H. pylori and nitrotyrosine. Results: Clinical features of DU are similar in patients with and without CLD. The main presentation was epigastric pain (70%) and bleeding (23%). Healing rate with omeprazole was higher in DU-CLD patients (90.7%) than in controls (80.8%). H. pylori was much lower in DU-CLD patients (51.2%) than controls (96.2%). Nitrotyrosine staining was negative in normal controls (0%) and positive in control-DU (100%), CLD-H. pylori positive (81%), and CLD-H. pylori negative (91%) cases. Conclusions: DU in patients with CLD is not different clinically from those without CLD. Omeprazole effectively and safely treats DU in CLD. Nitric oxide and free oxygen radicals may result in gastric mucosal changes in CLD similar to that caused by H. pylori. Patients and MethodsThis study was a prospective clinical trial on patients with active DU identi ed among patients referred to the Endoscopy Unit, Department of Gastroenterology and Hepatology and Infectious Disease, Benha University Hospital, Egypt. Patients were excluded if they could not give informed consent; if they were pregnant or lactating; if they had severe systemic diseases, such as renal failure, congestive heart failure, or severe ORIGINAL ARTICLE Ó 2001 Taylor & Francis Scand J Gastroenterol Downloaded from informahealthcare.com by Nyu Medical Center on 07/26/15 For personal use only. * Difference between groups P < 0.05. Scand J Gastroenterol 2001 (5) 480 W. A. Shahin et al. Scand J Gastroenterol Downloaded from informahealthcare.com by Nyu Medical Center on 07/26/15 For personal use only. CLD, chronic liver disease; DU, duodenal ulcer. Scand J Gastroenterol 2001 (5) 482 W. A. Shahin et al. Scand J Gastroenterol Downloaded from informahealthcare.com by Nyu Medical Center on 07/26/15For personal use only.