Helicobacter pylori infection and peptic ulcer disease in patients with advanced chronic liver disease

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Introduction Peptic ulcer disease (PUD) is more prevalent in patients with advanced chronic liver disease (ACLD) than in the general population. Helicobacter pylori (Hp) infection is the main aetiological factor in PUD. This study aims to assess the incidence, testing rate and eradication of Hp infection and PUD in patients with ACLD, along with the clinical impact of complicated PUD. Methods This retrospective study included patients with ACLD followed at the outpatient clinic of Unidade Local de Saúde de Braga between 2018 and 2022. The incidence, testing and eradication rates of Hp infection were assessed, as well as the presence of uncomplicated and complicated PUD. Results Of the 740 patients with ACLD, 295 (40%) were tested for Hp through oesophagogastroduodenoscopy (EGD) with gastric biopsies, of whom 125 (42%) tested positive for Hp. Of these, 53 patients (42%) underwent eradication. The EGD revealed PUD in 56 of the 295 patients (19%). In the multivariate analysis, Hp positivity (OR 2.328; p=0.007), alcohol consumption (OR 1.911; p=0.038) and no statin intake (OR 3.649; p=0.013) were independent predictors of uncomplicated PUD. Of the total 740 patients, 30 (4.1%) had complicated PUD (bleeding/perforation). 6 months after a complicated PUD episode, 12 patients (33%) had de novo/further hepatic decompensation, and 8 patients (27%) died due to decompensated ACLD. Conclusions The rate of Hp testing in patients with ACLD is low, while the incidence of Hp and PUD was high. Complicated PUD has significant morbidity in patients with ACLD. The testing and eradication of Hp in patients with complicated PUD are insufficient.

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