Advances in Therapy

, Volume 18, Issue 3, pp 140–150 | Cite as

Role ofHelicobacter pylori in cirrhotic patients with dyspepsia: A13C-urea breath test study

  • Jun-Lin Yeh
  • Yen-Chun Peng
  • Chun-Fang Tung
  • Gran-Hum Chen
  • Wai-Keung Chow
  • Chi-Sen Chang
  • Hong-Zen Yeh
  • Sek-Kwong Poon


The role ofHelicobacter pylori in dyspeptic, cirrhotic patients remains unclear. This prospective outpatient study, conducted to assess the relationship of gastroduodenal disease andH. pylori as determined by the (13C) urea breath test, enrolled 109 consecutive cirrhotic patients with dyspepsia. All patients underwent upper-gastrointestinal endoscopy, which revealed respective prevalences of peptic ulcer, gastric ulcer, and duodenal ulcer of 41.3%, 23.9%, and 22.9%;H. pylori infection was found in 52.3%. The rate of peptic ulcer disease in theH. pylori-positive (45.6%) and -negative (36.5%) groups was not significantly different; neither was the prevalence ofH. pylori in patients with or without portal hypertensive gastropathy and with or without esophageal varices. The relationship between peptic ulcer disease andH. pylori in dyspeptic patients with cirrhosis appears to be weak. Likewise, no significant relationship was evident betweenH. pylori and portal hypertensive gastropathy or esophageal varices. This organism may not be a major pathogenetic factor in gastroduodenal diseases in dyspeptic patients with cirrhosis.


cirrhosis (13C) urea breath test Helicobacter pylori peptic ulcer 


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  1. 1.
    Marshall BJ. Helicobacter pylori. Am J Gastroenterol. 1994;89:S116-S128.Google Scholar
  2. 2.
    Hentschel E, Brandstatter G, Dragosics B, et al. Effect of ranitidine and amoxicillin plus metronidazole on the eradication ofHelicobacter pylori and the recurrence of duodenal ulcer.N Engl J Med. 1993;328:308–312.PubMedCrossRefGoogle Scholar
  3. 3.
    Soll AH. Gastric, duodenal and stress ulcer. In: Sleisenger MH, Fordtran JS, eds.Gastrointestinal Disease. Philadelphia: WB Saunders; 1993:580–678.Google Scholar
  4. 4.
    Siringo S, Burroughs AK, Bolondi L, et al. Peptic ulcer and its course in cirrhosis: an endoscopic and clinical prospective study.J Hepatol. 1995;22:633–641.PubMedCrossRefGoogle Scholar
  5. 5.
    Siringo S, Di Febo G, Migliolo M, et al. Peptic ulceration and its complication in cirrhosis: an endoscopic and clinic survey in two centers.Hepatology. 1989;10:713. Abstract.Google Scholar
  6. 6.
    Siringo S, Vaira D, Menegatti M, et al. High prevalence ofHelicobacter pylori in liver cirrhosis: relationship with clinical and endoscopic features and the risk of peptic ulcer.Dig Dis Sci. 1997; 42:2024–2030.PubMedCrossRefGoogle Scholar
  7. 7.
    Wu CS, Lin CY, Liaw YF.Helicobacter pylori in cirrhotic patients with peptic ulcer diseases: a prospective, case controlled study.Gastrointest Endosc. 1995;42:424–427.PubMedCrossRefGoogle Scholar
  8. 8.
    The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study.N Engl J Med. 1988;319:983–989.CrossRefGoogle Scholar
  9. 9.
    Barbara L, Camilleri M, Corinaldesi R, et al. Definition and investigation of dyspepsia. Consensus of an international ad hoc working party.Dig Dis Sci. 1989;34:1272–1276.PubMedCrossRefGoogle Scholar
  10. 10.
    Maratka Z.Terminology, Definitions, and Diagnostic Criteria in Digestive Endoscopy. Englewood, NJ: Normed Verlag; 1994.Google Scholar
  11. 11.
    Staritz M, Poralla T, Meyer Zum Buschenfelde K-H. Intravascular oesophageal variceal pressure (IOVP) assessed by endoscopic fine needle puncture under basal conditions, Valsalva’s manoeuvre and after glyceryltrinitrate application.Gut. 1985;26:535–530.Google Scholar
  12. 12.
    Rigau J, Bosch J, Bordas JM, et al. Endoscopic measurement of variceal pressure in cirrhosis: correlation with portal pressure and variceal hemorrhage.Gastroenterology. 1989;96:873–880.PubMedGoogle Scholar
  13. 13.
    McCormack TT, Sims J, Eyre-Brook I, et al. Gastric lesion in portal hypertension: inflammatory gastritis or congestive gastropathy?Gut. 1985;26:1226–1236.PubMedCrossRefGoogle Scholar
  14. 14.
    McCormack PA, Sankey EA, Cardin F, Dhillon AP, McIntyre N, Burroughs AK. Congestive gastropathy andHelicobacter pylori: an endoscopic and morphometric study.Gut. 1991;32:351–354.CrossRefGoogle Scholar
  15. 15.
    Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of esophagus for bleeding esophageal varices.Br J Surg. 1973;60:646–649.PubMedCrossRefGoogle Scholar
  16. 16.
    Sheu BS, Lee SC, Yang HB, Lin XZ. Quantitative result of13C-urea breath test as early as 15 minutes may correlate well with the bacterial load ofH. pylori.Gut. 1997;41(suppl 2): A84. Abstract.Google Scholar
  17. 17.
    Sheu BS, Lee SC, Yang HB, et al. Selection of lower cutoff point of (13C) urea breath test is helpful to monitorH. pylori eradication after proton pump inhibitor-based triple therapy.Dig Dis Sci. 2000;45:1330–1336.PubMedCrossRefGoogle Scholar
  18. 18.
    Tabaqchali S, Dawson AM. Peptic ulcer and gastric secretion in patients with liver disease.Gut. 1964;5:417–421.PubMedCrossRefGoogle Scholar
  19. 19.
    Arakawa T, Satoh H, Fukuda T, Nakamura H, Kobayashi K. Endogenous prostaglandin E2 in gastric mucosa of patients with alcoholic cirrhosis and portal hypertension.Gastroenterology. 1987;93:135–140.PubMedGoogle Scholar
  20. 20.
    Ostrow JD, Timmerman RJ, Gray SJ. Gastric section in human hepatic cirrhosis.Gastroenterology. 1960;38:303–313.PubMedGoogle Scholar
  21. 21.
    Lam SK. Hypergastrinemia in cirrhosis of liver.Gut. 1976;17:700–708.PubMedCrossRefGoogle Scholar
  22. 22.
    Kakeyama J, Suzuki Y, Suzuki A, et al. Gastric mucus secretion in portal hypertension.J Gastroenterol Hepatol. 1989;4(suppl 1):126–128.Google Scholar
  23. 23.
    Guslandi M, Sorghi M, Foppa L, Pellegrini A, Tittobello A. Mucosal defensive mechanisms in congestive gastropathy.Gastroenterology. 1992;102:A816. Abstract.Google Scholar
  24. 24.
    Pienkowski P, Payen JL, Cales P, et al. Functional study, in man, of congestive gastropathy in cirrhosis by measurement of potential difference.Gastroenterol Clin Biol. 1989;13:763–768.PubMedGoogle Scholar
  25. 25.
    Sarfeh IJ, Tarnawski A, Malki A, Mason GR, Mach T, Ivey KJ. Portal hypertension and gastric mucosal injury in rats.Gastroenterology. 1983;84:987–993.PubMedGoogle Scholar
  26. 26.
    Sarfeh IJ, Tarnawski A, Maeda R, Raymont K, Mason GR, Ivey KJ. The gastric mucosa in portal hypertension: effects of topical bile acid.Scand J Gastroenterol. 1984;19(suppl 92):189–194.Google Scholar
  27. 27.
    Sarfeh IJ, Tarnawski A, Hajduczek A, Stachura J, Bui HX. Does portal hypertension predispose gastric mucosa to aspirin injury? Histological, ultrastructural and functional analysis.Gastroenterology. 1987;92:A1614. Abstract.Google Scholar
  28. 28.
    American Gastroenterological Association. Medical position statement: evaluation of dyspepsia.Gastroenterology. 1998;114:579–581.CrossRefGoogle Scholar
  29. 29.
    Wang CH, Mo LR, Lin RC, Kuo JY, Chang KK.Helicobacter pylori infection and risk of peptic ulcer among cirrhotic patients.J Formos Med Assoc. 1996;96:55–58.Google Scholar
  30. 30.
    Tsai CJ. Helicobacter pylori infection and peptic ulcer disease in cirrhosis.Dig Dis Sci. 1998;43: 1219–1225.PubMedCrossRefGoogle Scholar
  31. 31.
    Chen JJ, Changchien CS, Tai DI, Chiou SS, Lee CM, Kuo CH. Role ofHelicobacter pylori in cirrhotic patients with peptic ulcer: a serological study.Dig Dis Sci. 1994;39:1565–1568.PubMedCrossRefGoogle Scholar
  32. 32.
    Tytgat GN, Noach LA, Rauws EA.Helicobacter pylori infection and duodenal ulcer disease.Gastroenterol Clin North Am. 1993;22:127–139.PubMedGoogle Scholar
  33. 33.
    Fox JG, Wang TC.Helicobacter and liver disease.Ital J Gastroenterol Hepatol. 1997;29:5–12.PubMedGoogle Scholar
  34. 34.
    Nardone G, Coscione P, D’Armiento FP, et al. Cirrhosis negatively affects the efficiency of serologic diagnosis ofHelicobacter pylori infection.Ital J Gastroenterol. 1996;28:332–336.PubMedGoogle Scholar
  35. 35.
    Logan RP, Polson RJ, Misiewicz JJ, et al. Simplified single sample 13carbon urea breath test forHelicobacter pylori: comparison with histology, culture, and ELISA serology.Gut. 1991;32:1461–1464.PubMedCrossRefGoogle Scholar
  36. 36.
    Epple HJ, Kirstein FW, Bojarski C, et al.13C-urea breath test inHelicobacter pylori diagnosis and eradication. Correlation to histology, origin of ‘false’ results, and influence of food intake.Scand J Gastroenterol. 1997;32:308–314.PubMedCrossRefGoogle Scholar
  37. 37.
    Zullo A, Rinaldi V, Meddi P, et al.Helicobacter pylori infection in dyspeptic cirrhotic patients.Hepatogastroenterology. 1999;46:395–400.PubMedGoogle Scholar
  38. 38.
    Lin JT, Wang JT, Wu MS, Wang TH, Lee TK, Chen CJ. Seroprevalence study ofHelicobacter pylori infection in patients with gastroduodenal diseases. JFormos Med Assoc. 1994;93:122–127.PubMedGoogle Scholar
  39. 39.
    Chen LS, Lin HC, Lee FY, et al. Prevalence of duodenal ulcer in cirrhotic patients and its relation toHelicobacter pylori and portal hypertension.Chin Med J (Taipei). 1995;56:226–231.Google Scholar
  40. 40.
    Cutler AF. Diagnostic tests forHelicobacter pylori infection.Gastroenterologist. 1997;5:202–212.PubMedGoogle Scholar
  41. 41.
    Fraser AG, Pounder RE, Burroughs AK. Gastric secretion and peptic ulcer in cirrhosis.J Hepatol. 1993;19:171–182.PubMedCrossRefGoogle Scholar

Copyright information

© Health Communications Inc 2001

Authors and Affiliations

  • Jun-Lin Yeh
    • 1
  • Yen-Chun Peng
    • 1
  • Chun-Fang Tung
    • 1
  • Gran-Hum Chen
    • 2
  • Wai-Keung Chow
    • 3
  • Chi-Sen Chang
    • 3
  • Hong-Zen Yeh
    • 2
  • Sek-Kwong Poon
    • 1
  1. 1.Division of Gastroenterology Department of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
  2. 2.Division of Gastroenterology Department of Internal MedicineNational Yang-Ming UniversityTaipeiTaiwan
  3. 3.Division of Gastroenterology Department of Internal MedicineChung-Shan Medical and Dental CollegeTaichungTaiwan

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