Is There an Association between Variceal Bleed and Helicobacter pylori Infection in Cirrhotic Patients with Portal Hypertension?: A prospective cohort study.

OBJECTIVES

This study aimed to determine the association between infection and variceal bleeding as well as rebleeding in cases of cirrhosis with portal hypertension.

METHODS

This prospective cohort study included patients with bleeding oesophageal varices and was conducted at the Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, from August 2016 to July 2018.

RESULTS

A total of 190 patients were assessed for eligibility, of which 159 patients were included in this study. Among the 159 patients, 124 (78.0%) had alcohol-related liver disease and eight had hepatitis B virus-related liver disease. Seven patients with varices had bled neither at presentation nor during the follow-up period. A total of 78 (49.1%) patients were infected. The primary outcome, which was correlation between prevalence of and the incidence of bleeding/rebleeding from varices as well as encephalopathy found that patients with oesophageal varices (adjusted risk [AR] = 0.714) and infection (AR = 0.682) had a lower risk of variceal rebleeding. Among -negative patients, pepsinogen I was higher in patients with rebleeding (30.7 versus 14.4 ng/mL; <0.001). The secondary outcome, which was correlation of the site of bleeding with infection and the association of the ratio of pepsinogen I/II with bleeding showed that among -positive patients, the ratio of pepsinogen I/II was higher in patients with rebleeding (2.9 versus 1.3 ng/mL; = 0.023).

CONCLUSION

infection was associated with a lower risk of rebleeding in cases of cirrhosis with portal hypertension. Irrespective of the status of the infection, rebleeding was associated with increased levels of gastric acid output, as demonstrated by the level of pepsinogen.