Colonization by Helicobacter pylori and its relationship to histological changes in the gastric mucosa in portal hypertension

Abstract

In order to investigate the relationship between Helicobacter pylori infection of the gastric mucosa and mucosal changes in portal hypertension, gastric fundic and antral biopsies were obtained from 66 patients with portal hypertension and 49 controls with non-ulcer dyspepsia (NUD). Gastric mucosa from portal hypertensive patients exhibited typical vascular dilatation and congestion, while mild dilatation of lamina propria blood vessels was not uncommon in NUD patients with histological evidence of gastritis. Colonization of the gastric mucosa by H. pylori infection was significantly less in portal hypertension (51.5%) compared to controls (75.5%; P < 0.01). The difference was more apparent in patients with marked vascular dilatation (18.8% colonization) compared to patients with minimal vascular dilatation (66.7%). H. pylori infection was significantly associated with active superficial gastritis (P < 0.001), and with atrophic gastritis (P < 0.001), in both study groups. H. pylori-negative superficial gastritis was significantly more common in portal hypertension (25/66 patients) than in controls (7/49; P < 0.05). H. pylori infection was not more common in patients who had undergone repeated sclerotherapy. The results suggest that the gastric mucosa of portal hypertension does not provide a hospitable environment for H. pylori colonization, particularly when mucosal congestion is marked. H. pylori infection does not add significantly to the gastropathy of portal hypertension.

Low Incidence of Helicobacter pylori Infection in Patients with Duodenal Ulcer and Chronic Liver Disease

“…Some reports found no statistically signi cant correlation between the presence of H. pylori and the severity of liver disease or presence or absence of esophageal varices (24,25). Others reported a lower incidence of H. pylori in patients with esophageal varices (2,19). There is a reciprocal relationship between the severity of portal hypertensive gastropathy and H. pylori infection: the more severe the congestive gastropathy, the less the H. pylori infection (23).…”

“…There is no signi cant difference in the diagnostic accuracy of tests used in H. pylori detection between patients with or without cirrhosis (17). Of seven studies on H. pylori in CLD patients (2,(17)(18)(19)(20), histologic results were used in diagnosis of H. pylori in six of them. Also, the Giemsa stain is considered one of the best histologic methods to make an H. pylori diagnosis (21).…”

Does portal hypertension contribute to the pathogenesis of gastric ulcer associated with liver cirrhosis?

“…13 Two recent studies, in agreement with these findings, reported a decreased prevalence of Helicobacter pylori in patients with portal hypertension and liver cirrhosis. 14,15 Taken together, these data suggest that the gastric mucosa of patients with portal hypertension does not provide a hospitable environment for Helicobacter pylori colonization. Recently, the prevalence of Helicobacter pylori in cirrhosis patients with gastric ulcer has been evaluated.…”

Low Incidence ofHelicobacter pyloriInfection in Patients with Duodenal Ulcer and Chronic Liver Disease

“…Some reports found no statistically signi cant correlation between the presence of H. pylori and the severity of liver disease or presence or absence of esophageal varices (24,25). Others reported a lower incidence of H. pylori in patients with esophageal varices (2,19). There is a reciprocal relationship between the severity of portal hypertensive gastropathy and H. pylori infection: the more severe the congestive gastropathy, the less the H. pylori infection (23).…”