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El Sheref SEDM, Afify S, Berengy MS. Clinical characteristics and predictors of esophagogastric variceal bleeding among patients with HCV-induced liver cirrhosis: An observational comparative study. PLoS One 2022; 17:e0275373. [PMID: 36227871 PMCID: PMC9560135 DOI: 10.1371/journal.pone.0275373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 09/15/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To investigate the clinical characteristics, risk factors, and predictors of esophagogastric variceal bleeding in patients with hepatitis C virus (HCV)-induced liver cirrhosis. METHODS This comparative observational study was carried out on 100 patients suffering from post hepatitis cirrhosis and portal hypertension who were admitted to the Internal Medicine Department, Al-Azhar University Hospital, Damietta Egypt. Patients were classified into two groups: 50 of them presented with esophagogastric varices with acute variceal bleeding, and 50 patients presented without bleeding. Data were collected, coded, revised, and entered into the Stata software version 16. RESULTS The mean age of patients with bleeding was slightly higher than those without bleeding (55.58 ± 5.89 vs. 52.54 ± 9.01 years), p = 0.049. Mild ascites, positive H.Pylori, and Child-Pugh score B and C were an independent predictors of esophagogastric variceal bleeding (OR = 0.036, 95% CI: 0.0004-0.36; p = 0.005), (OR = 7.36, 95% CI: 1.44-37.59; p = 0.016), (OR = 19.0, 95% CI: 2.02-186.3; p = 0.010), and (OR = 40.51, 95% CI: 2.18-751.31; p = 0.013). The sensitivity of this model was 93.88%, specificity was 53.85%, PPV was 88.46%, NPV was 70.0%, correctly classified patients were 85.48%, and AUC was 90.27%. In the second model, pepsinogen level higher than 43.5 μg/l, AST (>54.5), Bilirubin (>1.45), and Hemoglobin (>11.5) were a significant independent predictors of esophagogastric variceal bleeding (OR = 1.18, 95% CI: 1.09-1.27; p<0.001), (OR = 1.14, 95% CI: 1.03-1.27; p = 0.007), (OR = 5.55, 95% CI: 1.21-25.43; p = 0.027), and (OR = 0.05, 95% CI: 0.008-0.32; p = 0.002), respectively. The sensitivity of this model was 92%, specificity was 98%, PPV was 97.87%, NPV was 92.45%, correctly classified patients were 95%, and AUC was 98.68%. CONCLUSION The independent predictors of esophagogastric variceal bleeding were ascites, positive H. pylori, Child-Pugh score B and C, pepsinogen level higher than 43.5 μg/l, AST (>54.5), bilirubin (>1.45), and hemoglobin (>11.5). Laboratory investigations are more reliable in predicting variceal bleeding and excluding non-variceal bleeding; however, clinical symptoms should not be neglected, especially H. pylori infection, ascites, and Child-Pugh score.
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Affiliation(s)
| | - Shimaa Afify
- Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Mahmoud S. Berengy
- Internal Medicine Department, Faculty of Medicine, Al-Azhar University Hospital, New Damietta, Egypt
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The Risk of Bleeding in Small/Straight Esophageal Varices with Red Color Sign on Endoscopy: A Retrospective Analysis from the Natural Course. Healthcare (Basel) 2022; 10:healthcare10071193. [PMID: 35885720 PMCID: PMC9322794 DOI: 10.3390/healthcare10071193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Red color sign-positive (RC-positive) esophageal varices present a high bleeding risk, necessitating prophylactic treatment. Among RC-positive esophageal varices, those classified morphologically as small straight varices (Form level 1: F1) are difficult to treat. Moreover, the appropriate time for therapeutic intervention remains undefined. This study assessed the bleeding risk in RC-positive F1 esophageal varices. After extracting 541 cases of F1 esophageal varices diagnosed during 1 January 2012−29 February 2020, 76 cases of RC-positive F1 esophageal varices were divided into two groups in terms of treatment intervention at diagnosis: 49 cases with (treatment group) and 27 cases without (follow-up group). We assessed the bleeding rates, bleeding-associated factors, and early-bleeding-associated factors. The treatment group’s bleeding rate was 10% (5/49). The follow-up group’s bleeding rate was 78% (21/24). The subsequent bleeding rate was low in the treatment group (p < 0.001). The median period of sustained absence of bleeding was longer in the treatment group than in the follow-up group (1156 [274−1582] days vs. 105 [1−336] days; p < 0.001). In the follow-up group, a significant number of bleedings had varices that included a hematocystic spot (HCS) as RC or combined with RC (p = 0.017). Early bleeding occurred often in varices that included HCS or combined with RC (p = 0.024). Red wale marking (RWM) only was not a factor of early bleeding (p = 0.012). In conclusion, RC-positive varices should be treated even as F1 varices. Patients with RWM only show the possibility of not accepting early treatment intervention. A fast response is crucially important in HCS cases because of its associated bleeding and early bleeding.
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Jun YK, Kim JW, Kim BG, Lee KL, Jung YJ, Kim W, Park HS, Lee DH, Koh SJ. Helicobacter pylori infection is not associated with portal hypertension-related gastrointestinal complications: A meta-analysis. PLoS One 2022; 17:e0261448. [PMID: 35061730 PMCID: PMC8782498 DOI: 10.1371/journal.pone.0261448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/02/2021] [Indexed: 11/18/2022] Open
Abstract
Despite the importance of Helicobacter pylori infection and portal hypertension (PH)-associated gastrointestinal (GI) diseases, such as esophageal varices and portal hypertensive gastropathy (PHG), the impact of H. pylori infection on PH-related GI complications has not yet been elucidated. This meta-analysis investigated the association between H. pylori infection and the risk of PH-related GI complications. An electronic search for original articles published before May 2020 was performed using PubMed, EMBASE, and the Cochrane Library. Independent reviewers conducted the article screening and data extraction. We used the generic inverse variance method for the meta-analysis, and Begg's rank correlation test and Egger's regression test to assess publication bias. A total of 1,148 cases of H. pylori infection and 1,231 uninfected controls were included from 13 studies. H. pylori infection had no significant association with esophageal varices [relative risk (RR) = 0.96, 95% confidence interval (CI) = 0.87-1.06 for all selected studies; RR = 0.95, 95% CI = 0.84-1.07 for cohort studies; odds ratio (OR) = 0.96, 95% CI = 0.60-1.54 for case-control studies]. Although H. pylori infection was significantly associated with PHG in case-control studies [OR = 1.86, 95% CI = 1.17-2.96], no significant differences were found in the cohort studies [RR = 0.98, 95% CI = 0.91-1.05] or all studies combined [RR = 1.18, 95% CI = 0.93-1.52]. In conclusion, H. pylori infection was not associated with the risk of PH-related GI complications. Clinicians should carefully treat cirrhotic patients with PH-related GI complications, regardless of H. pylori infection.
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Affiliation(s)
- Yu Kyung Jun
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Intestinal Mucosa and Skin Immunology, SMG-SNU Boramae medical Center, Seoul, Korea
| | - Ji Won Kim
- Laboratory of Intestinal Mucosa and Skin Immunology, SMG-SNU Boramae medical Center, Seoul, Korea
- Department of Internal medicine, Division of Gastroenterology, SMG-SNU Boramae medical Center, Seoul, Korea
| | - Byeong Gwan Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Kook Lae Lee
- Department of Internal medicine, Division of Gastroenterology, SMG-SNU Boramae medical Center, Seoul, Korea
| | - Yong Jin Jung
- Department of Internal medicine, Division of Gastroenterology, SMG-SNU Boramae medical Center, Seoul, Korea
| | - Won Kim
- Department of Internal medicine, Division of Gastroenterology, SMG-SNU Boramae medical Center, Seoul, Korea
| | - Hyun Sun Park
- Laboratory of Intestinal Mucosa and Skin Immunology, SMG-SNU Boramae medical Center, Seoul, Korea
- Department of Dermatology, SMG-SNU Boramae medical Center, Seoul, Korea
| | - Dong Hyeon Lee
- Department of Internal medicine, Division of Gastroenterology, SMG-SNU Boramae medical Center, Seoul, Korea
| | - Seong-Joon Koh
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Intestinal Mucosa and Skin Immunology, SMG-SNU Boramae medical Center, Seoul, Korea
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Yang TJ, Dhanasekar K, Bhandari R, Muraleedharan D, Chirindoth SS, Kaur H, Goswami R, Maiyani P, Desai M, Moradiya DV, Devani H, Patel AA. Association of Helicobacter Pylori With Development of Peptic Ulcer Disease Among Cirrhotic Patients: An Evidence From Population-Based Study. Cureus 2021; 13:e19315. [PMID: 34900489 PMCID: PMC8650630 DOI: 10.7759/cureus.19315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/28/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Helicobacter pylori (H. pylori) plays an important role in causing peptic ulcer disease (PUD) in the general population. However, the role of H. pylori in cirrhotic patients for causing PUD is obscure. There are various studies evaluating H. pylori association with PUD in cirrhotic patients, but the results have been controversial. We sought to analyze the association of H. pylori with the development of PUD in cirrhotic patients from the largest United States population-based database. METHODS We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data from 2017. Adult hospitalizations due to cirrhosis were identified by previously validated ICD-10-CM codes. PUD and H. pylori were identified with the presence of ICD-10-CM codes in primary and secondary diagnosis fields, respectively. We performed weighted analyses using Chi-Square and paired Student's t-test to compare the groups. Multivariable survey logistic regression was performed to find an association of H. pylori with PUD in cirrhotic patients. RESULTS Our study showed that the prevalence of H. pylori infection was 2.2% in cirrhotic patients with PUD. In regression analysis, H. pylori was found to be associated with PUD in cirrhotic patients (OR 15.1; 95% CI: 13.9-16.4; p <0.001) and non-cirrhotic patients (OR 48.8; 95% CI: 47.5-50.1; p <0.001). In the studied population, H. pylori was more commonly seen in the age between 50 and 64 years (49.4% vs 44.1%; p <0.0001), male (63.4% vs 59.9%; p <0.0413), African American (16.3% vs 10.6%; p <0.0001), and Hispanic (26.2% vs 14.9%; p <0.0001). H. pylori is more likely to be associated with complicated PUD hospitalizations (51.2% vs 44.2%; p <0.0067). Alcoholism and smoking were more common in H. pylori group compared to those without (43.6% vs 35.8%; p <0.0001 and 33.7% vs 24.8% p <0.0001, respectively). Factors associated with increased odds of H. pylori infection include African American (OR 2.3, 95% CI: 1.5-3.6), Hispanic (OR 2.6, 95% CI: 1.7-4.0), and smoking (OR 1.5, 95% CI: 1.1-2.2). CONCLUSION H. pylori are associated with PUD and concurrent cirrhosis, although it is less prevalent than general population. African American, Hispanic, and smoking were independently associated with increased odds of H. pylori infection. Further studies are required to better understand the epidemiology and confirm our findings.
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Affiliation(s)
- Tsu Jung Yang
- Hospital Medicine, MultiCare Good Samaritan Hospital, Puyallup, USA
| | | | - Renu Bhandari
- Medicine, Manipal College of Medical Sciences, Kaski, NPL
| | | | | | - Harpreet Kaur
- Internal Medicine, BronxCare Health System, Bronx, USA
| | - Ruchir Goswami
- Epidemiology and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Prakash Maiyani
- Internal Medicine, Gold Coast University Hospital, Southport, AUS
| | - Maheshkumar Desai
- Internal Medicine, Hamilton Medical Center, Medical College of Georgia/Augusta University, Augusta, USA
| | | | - Hiteshkumar Devani
- Dental Medicine, University of Pittsburgh School of Dental Medicine, Pittsburgh, USA
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Koya Y, Shibata M, Watanabe T, Kumei S, Miyagawa K, Oe S, Honma Y, Kume K, Yoshikawa I, Harada M. Influence of gastroesophageal flap valve on esophageal variceal bleeding in patients with liver cirrhosis. Dig Endosc 2021; 33:100-109. [PMID: 32274835 DOI: 10.1111/den.13685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/01/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Esophageal variceal bleeding can be fatal in patients with liver cirrhosis. The aim of this study was to investigate the relationship between gastroesophageal flap valve (GEFV) and esophageal variceal bleeding. METHODS Subjects were cirrhotic patients with endoscopically diagnosed esophageal varices treated at our hospital between 2005 and 2019, excluding those with F3 form and red color (RC) signs at first endoscopy. Sixty-five patients with normal GEFV (Hill grade I or II) and 42 with abnormal GEFV (Hill grade III or IV) were enrolled. Propensity score matching eliminated the baseline differences, resulting in a sample size of 30 patients per cohort. The primary endpoint was esophageal variceal bleeding, and the secondary endpoint was variceal bleeding or appearance of RC sign. We analyzed the cumulative incidences and predictors of each endpoint. RESULTS The 3-, 5-, and 10-year cumulative incidences of the primary endpoints were all 3.4% in the normal GEFV group, and 19.0%, 24.6% and 34.0% in the abnormal GEFV group, respectively (log-rank P = 0.011). Cumulative incidence of the secondary endpoint was 13.8%, 33.1% and 39.2% in the normal GEFV group, and 42.2%, 54.6% and 84.9% in the abnormal GEFV group, respectively (log-rank P = 0.001). In multivariate Cox regression analyses, hazard ratios of abnormal GEFV of the primary and secondary endpoints were 12.79 (95% confidence interval 1.331-122.8) and 3.600 (1.653-7.840), respectively. CONCLUSIONS Abnormal GEFV was an independent risk factor for esophageal variceal bleeding and appearance of RC sign.
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Affiliation(s)
- Yudai Koya
- Departments of, Department of, Third Department of Internal Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Michihiko Shibata
- Departments of, Department of, Third Department of Internal Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Tatsuyuki Watanabe
- Departments of, Department of, Third Department of Internal Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Shinsuke Kumei
- Departments of, Department of, Third Department of Internal Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Koichiro Miyagawa
- Departments of, Department of, Third Department of Internal Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Shinji Oe
- Departments of, Department of, Third Department of Internal Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yuichi Honma
- Departments of, Department of, Third Department of Internal Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Keiichiro Kume
- Departments of, Department of, Third Department of Internal Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Ichiro Yoshikawa
- Department of, Endoscopy, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Masaru Harada
- Departments of, Department of, Third Department of Internal Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
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Elsebaey MA, Tawfik MA, Elshweikh SA, Negm MS, Elnaggar MH, Alghazaly GM, Abd-Elsalam S. Impact of Helicobacter pylori Infection on Gastric Variceal Bleeding among Patients with Liver Cirrhosis. Gastroenterol Res Pract 2019; 2019:6529420. [PMID: 30881448 PMCID: PMC6387698 DOI: 10.1155/2019/6529420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/03/2018] [Accepted: 01/01/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIMS Currently, it is well known that Helicobacter pylori- (H. pylori-) related peptic ulcer is one of the main causes of nonvariceal bleeding in cirrhotic patients. However, there is a lack of data to identify the exact effect of H. pylori infection on variceal bleeding. This study was conducted to identify the impact of H. pylori infection on gastric variceal bleeding in cirrhotic patients. PATIENTS AND METHODS 76 cirrhotic patients with gastric varices were included in this prospective study and divided into 2 groups: nonbleeding gastric varices (32 patients) and bleeding gastric varices (44 patients). The fasting serum gastrin level was measured. Mucosal biopsies from the gastric body and antrum were examined to determine the patterns of gastritis and the presence of H. pylori. RESULTS The frequency of H. pylori infection in the studied patients was 59.2%. There were significant differences between both groups regarding liver decompensation (P = 0.001), red color sign over gastric varices (P = 0.0011), prevalence of H. pylori infection (P = 0.0049), histological patterns of gastritis (P = 0.0069), and serum gastrin level (P = 0.0200). By multivariate analysis, Child C cirrhosis, red color sign over gastric varices, and H. pylori-induced follicular gastritis were independent risk factors for bleeding from gastric varices. CONCLUSION H. pylori-induced follicular gastritis is considered as an additional risk factor for bleeding from gastric varices.
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Shen SH, Liu YD, Sun X, Li M, Sun GH, Wang J, Liu JT, Tie J, Yang J. Study of the association between hemorrhage and the position of hemorrhagic stigmata in patients with esophageal varices. Exp Ther Med 2017; 14:2261-2264. [PMID: 28962152 DOI: 10.3892/etm.2017.4727] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 03/23/2017] [Indexed: 01/29/2023] Open
Abstract
The aim of the present study was to investigate the predilection position of hemorrhagic stigmata (HS) in patients with esophageal variceal hemorrhage and provide guidance on endoscopic therapy for esophageal varices. The clinical characteristics, particularly the endoscopic manifestations of HS, in the patients who presented with gastroesophageal variceal hemorrhage and cirrhosis between January 2003 and December 2013 at our hospital were summarized and patients were grouped according to the distance of the lesion site to incisors at 35-40 and ~30 cm. The association between the location of HS and active hemorrhage was assessed. The location of hemorrhage and HS at 35-40 cm from the incisors was more common in esophageal varices patients, followed by the location at ~30 cm from the incisors (P<0.0001). The incidence of HS in esophageal varices patients in the 35-40 cm group was significantly higher than that in the ~30 cm group except for HS at 9:00 position (P<0.0001). The highest incidence of HS in the ~30 cm group was at the 3:00 position, followed by the 12:00, 6:00 and 9:00 position. Among them, there were significant differences between the 3:00 and 6:00 position, the 3:00 and 9:00 position, and the 9:00 and 12:00 position (P<0.05). The order in the 35-40 cm group was similar to that in the ~30 cm group and the incidence of HS at the 9:00 position was lowest (P<0.05). A certain association between the point of location of HS and hemorrhage was identified. HS located at 35-40 cm from the lesion site to incisors was identified to be most likely to bleed, followed by that located at ~30 cm. In addition, the incidence of HS at 9:00 position was found to be lower than that in the other positions. Therefore, HS located at ~30 cm and 35-40 cm from the lesion site to incisors should be paid attention to and the 3:00, 12:00 and 6:00 rather than the 9:00 position should be prioritized during endoscopic treatment, particularly in emergency situations.
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Affiliation(s)
- Shao-Hua Shen
- Department of Gastroenterology and Hepatology, PLA General Hospital, Beijing 100853, P.R. China
| | - Ying-Di Liu
- Department of Gastroenterology and Hepatology, PLA General Hospital, Beijing 100853, P.R. China
| | - Xiao Sun
- Department of Gastroenterology and Hepatology, PLA General Hospital, Beijing 100853, P.R. China
| | - Meng Li
- Department of Gastroenterology and Hepatology, PLA General Hospital, Beijing 100853, P.R. China
| | - Guo-Hui Sun
- Department of Gastroenterology and Hepatology, PLA General Hospital, Beijing 100853, P.R. China
| | - Juan Wang
- Department of Gastroenterology and Hepatology, PLA General Hospital, Beijing 100853, P.R. China
| | - Jiang-Tao Liu
- Department of Gastroenterology, Hainan Branch of PLA General Hospital, Sanya, Hainan 572000, P.R. China
| | - Jun Tie
- Department of Gastroenterology and Hepatology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Jing Yang
- Department of Gastroenterology, Hainan Branch of PLA General Hospital, Sanya, Hainan 572000, P.R. China
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Huang J, Cui J. Evaluation of Helicobacter pylori Infection in Patients with Chronic Hepatic Disease. Chin Med J (Engl) 2017; 130:149-154. [PMID: 28091405 PMCID: PMC5282670 DOI: 10.4103/0366-6999.197980] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: The 13C urea breath test (13C-UBT) is the gold standard for detecting Helicobacter pylori infection. H. pylori pathogenesis in patients with hepatitis B virus (HBV) and related diseases remains obscure. We used 13C-UBT to detect H. pylori infection in patients with chronic HBV infection, HBV-related cirrhosis, HBV-related hepatic carcinoma, and other chronic hepatic diseases. Methods: A total of 131 patients with chronic hepatitis B (HB), 179 with HBV-related cirrhosis, 103 with HBV-related hepatic carcinoma, 45 with HBV-negative hepatic carcinoma, and 150 controls were tested for H. pylori infection using 13C-UBT. We compared H. pylori infection rate, liver function, complications of chronic hepatic disease, serum HBV-DNA, serum alpha-fetoprotein (AFP), and portal hypertensive gastropathy (PHG) incidence among groups. Results: HBV-related cirrhosis was associated with the highest H. pylori infection rate (79.3%). H. pylori infection rate in chronic HB was significantly higher than in the HBV-negative hepatic carcinoma and control groups (P < 0.001). H. pylori infection rate in patients with HBV-DNA ≥103 copies/ml was significantly higher than in those with HBV-DNA <103 copies/ml (76.8% vs. 52.4%, P < 0.001). Prothrombin time (21.3 ± 3.5 s vs. 18.8 ± 4.3 s), total bilirubin (47.3±12.3 μmol/L vs. 26.6 ±7.9 μmol/L), aspartate aminotransferase (184.5 ± 37.6 U/L vs. 98.4 ± 23.5 U/L), blood ammonia (93.4 ± 43.6 μmol/L vs. 35.5 ± 11.7 μmol/L), and AFP (203.4 ± 62.6 μg/L vs. 113.2 ± 45.8 μg/L) in the 13C-UBT-positive group were significantly higher than in the 13C-UBT-negative group (P < 0.01). The incidence rates of esophageal fundus variceal bleeding (25.4% vs. 16.0%), ascites (28.9% vs. 17.8%), and hepatic encephalopathy (24.8% vs. 13.4%) in the 13C-UBT-positive group were significantly higher than in the 13C-UBT-negative group (P < 0.01). The percentages of patients with liver function in Child-Pugh Grade C (29.6% vs. 8.1%) and PHG (43.0% vs. 24.3%) in the 13C-UBT-positive group were significantly higher than in the 13C-UBT-negative group (P < 0.05). Conclusions: It is possible that H. pylori infection could increase liver damage caused by HBV. H. pylori eradication should be performed in patients with complicating H. pylori infection to delay hepatic disease progression.
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Affiliation(s)
- Ju Huang
- Department of Clinical Medicine, Queen Mary School of Nanchang University, Nanchang, Jiangxi 330031, China
| | - Jun Cui
- Department of Gastroenterology, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China
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Licinio R, Losurdo G, Carparelli S, Iannone A, Giorgio F, Barone M, Principi M, Ierardi E, Di Leo A. Helicobacter pylori, liver cirrhosis, and portal hypertension: an updated appraisal. Immunopharmacol Immunotoxicol 2016; 38:408-413. [PMID: 27788611 DOI: 10.1080/08923973.2016.1247855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Helicobacter pylori (H. pylori) is the most common cause of gastritis and peptic ulcer. However, H. pylori is even involved in extragastric diseases, and it has been hypothesized that H. pylori could be a risk factor for several hepatic diseases. For instance, a direct involvement of H. pylori in the development of portal hypertension (PH) in cirrhotic patients has been postulated. METHODS We performed a literature search in major databases to elucidate the relationship between H. pylori, portal hypertension, and liver cirrhosis. RESULTS The effect of H. pylori on PH may be multifactorial. Endothelial dysfunction, alterations in the vasodilating dynamics, and neoangiogenesis are the most appealing theories about this issue, but the proofs come mainly from experimental studies, therefore a solid pathophysiological basis is still to be demonstrated. Congestive gastropathy (CG) and gastric antral vascular ectasia (GAVE) are two common endoscopic entities responsible for acute/chronic upper gastrointestinal bleeding, and a link with H. pylori has been hypothesized: the gastric mucosa, exposed to H. pylori, could develop both inflammatory microcirculatory alterations and thrombi, resembling the histologic pattern of GAVE. CONCLUSIONS Despite clues for an association between H. pylori and PH have been shown, these evidences are mostly experimental, therefore, in the absence of a direct proof on human beings, the role of H. pylori in the development of PH is uncertain. However, since this germ may be a cause of peptic ulcer, it should be found and eradicated in cirrhotic patients to reduce the risk of blood loss anemia.
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Affiliation(s)
- Raffaele Licinio
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Giuseppe Losurdo
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Sonia Carparelli
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Andrea Iannone
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Floriana Giorgio
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Michele Barone
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Mariabeatrice Principi
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Enzo Ierardi
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
| | - Alfredo Di Leo
- a Department of Emergency and Organ Transplantation , Section of Gastroenterology, AOU Policlinico , Bari , Italy
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10
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Li XP, Liu Y, Zhang CQ. Correlation Between NAT2 Gene Polymorphism and Cirrhotic Portal Hypertension in the Chinese Population. Genet Test Mol Biomarkers 2015; 19:138-43. [PMID: 25574899 DOI: 10.1089/gtmb.2014.0283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Xiao-Pei Li
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China
- Department of Gastroenterology, Tai'an Central Hospital, Tai'an, People's Republic of China
| | - Ying Liu
- Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chun-Qing Zhang
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China
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Lee YY, Tee HP, Mahadeva S. Role of prophylactic antibiotics in cirrhotic patients with variceal bleeding. World J Gastroenterol 2014; 20:1790-1796. [PMID: 24587656 PMCID: PMC3930977 DOI: 10.3748/wjg.v20.i7.1790] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 10/21/2013] [Accepted: 01/06/2014] [Indexed: 02/06/2023] Open
Abstract
Bacterial infections are common in cirrhotic patients with acute variceal bleeding, occurring in 20% within 48 h. Outcomes including early rebleeding and failure to control bleeding are strongly associated with bacterial infection. However, mortality from variceal bleeding is largely determined by the severity of liver disease. Besides a higher Child-Pugh score, patients with hepatocellular carcinoma are particularly susceptible to infections. Despite several hypotheses that include increased use of instruments, greater risk of aspiration pneumonia and higher bacterial translocation, it remains debatable whether variceal bleeding results in infection or vice versa but studies suggest that antibiotic prophylaxis prior to endoscopy and up to 8 h is useful in reducing bacteremia and spontaneous bacterial peritonitis. Aerobic gram negative bacilli of enteric origin are most commonly isolated from cultures, but more recently, gram positives and quinolone-resistant organisms are increasingly seen, even though their clinical significance is unclear. Fluoroquinolones (including ciprofloxacin and norfloxacin) used for short term (7 d) have the most robust evidence and are recommended in most expert guidelines. Short term intravenous cephalosporin (especially ceftriaxone), given in a hospital setting with prevalent quinolone-resistant organisms, has been shown in studies to be beneficial, particularly in high risk patients with advanced cirrhosis.
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The Relation between Helicobacter pylori Infection and Acute Bacterial Diarrhea in Children. Int J Pediatr 2014; 2014:191643. [PMID: 24696690 PMCID: PMC3950475 DOI: 10.1155/2014/191643] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/11/2014] [Accepted: 01/12/2014] [Indexed: 01/04/2023] Open
Abstract
Background. H. pylori infection leads to chronic gastritis in both children and adults. But recently, there are arising theories of its protective effect in diarrheal diseases. Aim. To explore the prevalence of H. pylori infection in children with bacterial diarrhea and compare it with healthy controls. Patients and Methods. Two matched groups consisted of 122 consecutive children, aged 24–72 months old, with acute bacterial diarrhea, who had Shigellosis (N = 68) and Salmonellosis (N = 54) as patients group and 204 healthy asymptomatic children as control group enrolled in this study. Results. The prevalence of H. pylori infection in healthy control children was significantly higher than in patients group, (odds ratio = 3.6, 95% CI: 1.33–9.5, P = 0.007). In our study, only 2/54 Salmonella infected patients and 3/68 of Shigellosis had evidence of H. pylori infection, while normal control children had 27/204 infected individuals. Conclusion. H. pylori infection may play a protective role against bacterial diarrhea in children. So it is important to consider all of the positive and negative aspects of H. pylori infection before its eradication.
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