Helicobacter pylori as an Initiating Factor of Complications in Patients With Cirrhosis: A Single-Center Observational Study

Ahmed Abdel-Razik; Nasser Mousa; Rania Elhelaly; Rasha Elzehery; Ahmad S Hasan; Mostafa Abdelsalam; Ahmed Salah Seif; Ahmed M Tawfik; Niveen El-Wakeel; Waleed Eldars

doi:10.3389/fmed.2020.00096

Helicobacter pylori as an Initiating Factor of Complications in Patients With Cirrhosis: A Single-Center Observational Study

Front Med (Lausanne). 2020 Mar 24:7:96. doi: 10.3389/fmed.2020.00096. eCollection 2020.

Authors

Affiliations

¹ Tropical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
² Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
³ Nephrology and Dialysis Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
⁴ Scientific Fellow of Tropical Medicine, Hepatology and Gastroenterology Department, Shebin Elkom Teaching Hospital, Menoufia, Egypt.
⁵ Diagnostic & Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
⁶ Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
⁷ Medical Microbiology and Immunology Department, Faculty of Medicine, Delta University for Science and Technology, Talkha, Egypt.

Abstract

Background and Aim: The relationship between liver cirrhosis and Helicobacter pylori (H. pylori) is a debatable matter. The aim of this study is to evaluate the possible association between H. pylori infection and liver cirrhosis. Methods: A single-center prospective cohort pilot study of 558 patients with cirrhosis was followed up for 1 year. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), nitric oxide (NO), vascular endothelial growth factor (VEGF) levels and Fecal H. pylori antigen were evaluated by enzyme-linked immunosorbent assay (ELISA). All patients with positive H. pylori were treated and then followed up for 3 months. Participants with eradicated H. pylori were followed up for one further year. Results: H. pylori-positive patients (48.4%) were associated with increased levels of serum CRP, TNF-α, IL-6, NO, and VEGF, as well as increased incidence of varices, portal hypertensive gastropathy, gastric antral vascular ectasia, hepatocellular carcinoma (HCC), spontaneous bacterial peritonitis, hepatic encephalopathy, portal vein thrombosis (PVT), and hepatorenal syndrome (all P < 0.05). Multivariate analysis models revealed that the presence of H. pylori was an independent risk variable for the development of portal vein thrombosis and hepatocellular carcinoma (P = 0.043, P = 0.037) respectively. After treatment of H. pylori infection, there was a significant reduction in all measured biochemical parameters and reported cirrhotic complications (all P < 0.05). Conclusion: Incidence of PVT and HCC development increased with H. pylori infection through increased inflammatory markers and vascular mediators. Moreover, its eradication may reduce the incidence of these complications.

Keywords: C-reactive protein; Helicobacter pylori; hepatic encephalopathy; hepatocellular carcinoma; liver cirrhosis; portal vein thrombosis; spontaneous bacterial peritonitis.