الفهرس 
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Abstract
This study was carried out at National Liver Institute, Menoufyia University. The
aim of this work was to investigate the role of H. pylori in patients with chronic liver
disease in Egypt and to fulfill this aim one hundred patients were classified into:
• group I: Consisted of 40 patients who had bilha rzia I liver disease.
• group II: Consisted of 30 patients who had chronic viral liver disease.
• Control: Consisted of 30 patients who had gastro-intestinal disease without liver disease.
These patients were subjected to careful history taking, full clinical examination,
abdominal ultrasonography and laboratory investigations. The laboratory investigations
included complete blood picture, liver function tests, coagulation tests, virological
liver tests, schistosoma I diagnostic tests, renal function tests and sero-diagnosis for
H. pylori (ELISA). The severity of cirrhosis was assessed by Pugh’s modification of Child’s
criteria. The upper gastro-intestinal endoscopy was perfonned consecutively to
evaluate the oesophagus, stomach, duodenum and entails the sampling of gastriC tissues
that was colonized by H. pylori for urease test and antral histopathological examination.
All chronic liver diseased patients had percutaneous liver biopsies, were evaluated
blindly by a single liver histopathologist. The histological changes of chronic hepatitis were
classified according to the classification system proposed by Ishak and his colleagues
(1995).
Patients were excluded if they; were unwilling to partiCipate, had systemic or
autoimmune or coagulation disorders, required emergency upper endoscopy, under
treatment or exposed recently to anti-H. pylori drugs as antibiotics, proton pump
inhibitors, H2 blockers, bismuth subcitrate or metronldazol.
All patients were recuited into the study; there 88 males and 12 females. There was no
significant difference as regards to age among the study groups. There was no Significant
difference as regards to sex between the H. pylori-positive and H. pylori-negative chronic
liver disease patients (P>0.05).
The prevalence of H. pylori by using urease test was about (75%) among bilharzia I
patients (GI) and was about (80%) among chronic viral liver diseased patients (GII). There
was no significant statistical difference (P>0.05). The prevalence of H. pylori was about
(36.7%) among gastro-intestinal diseased patients without liver disease (control group).
The prevalence of H. pylori by using ELlSA-seropositivity was about (85%) among
bilharzial (GI) and was about (93.3%) among chronic viral liver diseased patients (GII). The
prevalence of H. pylori was about (63.3%) among control group.
H. pylori prevalence by the antral histopathological examination was about (65%,
63.3% and 26.6% among GI, GII and control group respectively).
The prevalence of H. pylori infection among patients with HBV positive-chronic liver
disease was about (41.7%) of urease test positive and about (46.4%) of sero-positive
H. pylori-ELISA.
The prevalence of H. pylori infection among patients with HCV positive-chronic liver
disease was about (87.5%) of urease test positive and about (89.3%) of sero-positive
H. pylori-ELISA.
The severity of cirrhosis was assessed by Pugh’s modification of Child’s criteria. The
prevalence of H. pylori infection among Child’s A, Child’s B and Child’s C of chronic viral
liver diseased patients were about (69.2%, 90.9% and 83.3% respectively), distributed by
urease test and were increased by using seropositive H. pylori-ELISA to about (84.6%, 100%
and 100%) respectively.
These results indicated that there were high prevalence of H. pylori infection among
chronic liver diseased patients as schistosomal hepatic fibrosis (75%), chronic hepatitis
(69.2%), compensated cirrhosis (80.05%) and decompensated cirrhosis (83.3%) by using
urease test (P>0.05).
Again, the prevalences of H. pylori infection were increased as schistosoma I hepatic
fibrosis (85%), chronic viral hepatitis (84.6%), compensated cirrhosis (92.3%) and
decompensated cirrhosis (100%) by using seropositive H. pylori-ELISA (P>0.05).
There were no statistical significant differences between the positive H. pylori among
bilharzia I (GI) and each of chronic viral liver diseased patients (GII) and control group,
distributed by urease test in most of the biochemical tests (P>0.05). However, there were
statistical significant differences between the positive H. pylori among chronic viral liver
diseased patients (GII) and control group, distributed by urease test in most of the
biochemical tests (P<0.05).
There were no statistical Significant differences between the positive and negative
H. pylori among chronic viral liver diseased patients (GII), distributed by urease test as
regards to ascites (P>0.05).
Endoscopic findings
There were insignificant statistical differences between the oesophageal varices
and the high prevalence of H. pylori infection among chronic viral liver diseased
patients. The prevalence of H. pylori among cirrhotics with and without varices did not
showed a statistical significant difference (P>0.05).
The antral hyperemia (mosaic pattern) was found in about (56.7%,66.7% and 45.5%)
of urease test positive with high H. pylori prevalence (about 85%,88.9% and 71.4%) among
bilharzia I, chronic viral liver diseased patients and control group respectively. There was no
significant difference between chronic liver diseased patients (GI and GII) (P=0.28).
Gastric ulcer was found in about (16.7%, 12.5% and 27.3%) of positive urease test
with high H. pylori prevalence (about 71.4%, 75% and 75%) among bilharzial, chronic viral
liver diseased patients and control group respectively. There were no statistical significant
differences between matching groups (P>0.05).
Duodenal ulcer was found in about (13.3%, 16.7% and 36.4%) of positive urease
test with high H. pylori prevalence (about 100%) by urease test and seropositive- ELISA.
among bilharzial, chronic viral liver diseased patients and control group respectively.
There were no statistical significant differences between the matching groups (P>0.05).
Endoscopic gastritis was found in (20%, 33.3% and 36.4%) of urease test positive
with high H. pylori prevalence (about 66.7%,80% and 66.7%) among bilharzial, chronic viral
liver diseased patients and control group respectively. There were no statistical significant
differences between the matching groups (P>0.05).
Gastro-duodenitis was found in (16.7%, 16.7% and 18.2%) of urease test positive
with high H. pylori prevalence by urease test and seropositive-ELISA. (about 100%)
among bilharzial, chronic viral liver diseased patients and control group respectively.
There were no statistical significant differences between matching groups (P>0.05).
Gastric erosion was found in about (13.3%, 4.2% and 9.1%) of urease test positive
with high H. pylori prevalence by urease test and seropositive- ELISA among bilharzia I,
chronic viral liver diseased patients and control group respectively. There were no
statistical significant differences between matching groups (P>0.05).
Oesophagitis was found in about (10%. 8.3% and 18.2%) of urease test positive
with H. pylori prevalence by urease (about 60%. 50% and 50%) among bilharzial, chronic
viral liver diseased patients and control group respectively. There were no statistical
significant differences between H. pylori positive and negative patients among the studied
groups (P>0.05).
There were an association of H. pylori prevalence with duodenal ulcer, gastro-
duodenitis, antral hyperemia, gastric ulcer, gastric erosions and endoscopic gastritis
more than oesophagitis in chronic liver diseased patients.
There were high H. pylori prevalence in cirrhotics than in control group, but there was
no statistical significant differences between chronic liver diseased patients and control
group as regaeds to endoscopic findings. H. pylori infection was implicated in
pathogenesis of peptic ulcer in cirrhotic patients similar to findings in non-cirrhotics.
Histopathological examination
A- Antral Histology:
Histological examination for antral histopathological changes and H. pylori
detection showed that the gram negative spiral micro-organisms of H. pylori was identified
at (65%, 63.3% and 26.6%) among bilharzia I, chronic viral liver diseased patients and control
group respectively.
Chronic active superficial gastritis was found in about (55%, 63.3% and 50%)
with high H. pylori prevalence by urease test (about 66.7%, 62.5% and 63.6%) among the
studied groups respectively. There was statistical significant difference between bilharzial
and matching groups (chronic viral fIVer diseased patients and control group) (P=O.02).
Atrophic gastritis was found in about (17.5%, 20% and 40%) with H. pylori prevalence
by urease test (about 20%, 25% and 27.3%) among the studied groups respectively. There
were no statistical Significant differences between the matching groups (P=0.47).
Mucosal hyperplasia with immature intestinal metaplaSia and gland changes
were found in about (27.5%, 16.7% and 10%) with H. pylori prevalence by urease test
(about 23.3%, 20.8% and 18.2%) among the studied groups respectively. There were no
statistical significant differences between the matching groups (P=0.25). There were no statistical significant differences between the positive and negative
H. pylori among the studied groups as regards to the antral histopathology findings,
distributed by seropositive H. pylori-ELiSA (P>O.05).
8- Hepatic histopathology for chronic liver diseased patients:
The current study showed that there were no statistical significant differences
between H. pylori prevalence and hepatic histopathological examination, distributed by
urease test and seropositive H. pylori-ELiSA. (P>O.05).
This hepatic histopathological examination provides absence of characteristic
H. pylori micro-organism and its related inflammation in liver biopsy. These indicated that
the severity of liver diseases seemed to be an independent to H. pylori infection.