Association of Helicobacter Pylori With Development of Peptic Ulcer Disease Among Cirrhotic Patients: An Evidence From Population-Based Study

Tsu Jung Yang; Krithika Dhanasekar; Renu Bhandari; Divya Muraleedharan; Swathy S Chirindoth; Harpreet Kaur; Ruchir Goswami; Prakash Maiyani; Maheshkumar Desai; Dharmeshkumar V Moradiya; Hiteshkumar Devani; Achint A Patel

doi:10.7759/cureus.19315

Association of Helicobacter Pylori With Development of Peptic Ulcer Disease Among Cirrhotic Patients: An Evidence From Population-Based Study

Cureus. 2021 Nov 6;13(11):e19315. doi: 10.7759/cureus.19315. eCollection 2021 Nov.

Affiliations

¹ Hospital Medicine, MultiCare Good Samaritan Hospital, Puyallup, USA.
² Internal Medicine, Sterling Medical Center, Sterling Heights, USA.
³ Medicine, Manipal College of Medical Sciences, Kaski, NPL.
⁴ Internal Medicine, Larkin Community Hospital, South Miami, USA.
⁵ Internal Medicine, Kannur Medical College, Kannur, IND.
⁶ Internal Medicine, BronxCare Health System, Bronx, USA.
⁷ Epidemiology and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA.
⁸ Internal Medicine, Gold Coast University Hospital, Southport, AUS.
⁹ Internal Medicine, Hamilton Medical Center, Medical College of Georgia/Augusta University, Augusta, USA.
¹⁰ Internal Medicine, St. John of God Murdoch Hospital, Murdoch, AUS.
¹¹ Dental Medicine, University of Pittsburgh School of Dental Medicine, Pittsburgh, USA.
¹² Internal Medicine, Oak Hill Hospital, Brooksville, USA.

Abstract

Background: Helicobacter pylori (H. pylori) plays an important role in causing peptic ulcer disease (PUD) in the general population. However, the role of H. pylori in cirrhotic patients for causing PUD is obscure. There are various studies evaluating H. pylori association with PUD in cirrhotic patients, but the results have been controversial. We sought to analyze the association of H. pylori with the development of PUD in cirrhotic patients from the largest United States population-based database.

Methods: We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data from 2017. Adult hospitalizations due to cirrhosis were identified by previously validated ICD-10-CM codes. PUD and H. pylori were identified with the presence of ICD-10-CM codes in primary and secondary diagnosis fields, respectively. We performed weighted analyses using Chi-Square and paired Student's t-test to compare the groups. Multivariable survey logistic regression was performed to find an association of H. pylori with PUD in cirrhotic patients.

Results: Our study showed that the prevalence of H. pylori infection was 2.2% in cirrhotic patients with PUD. In regression analysis, H. pylori was found to be associated with PUD in cirrhotic patients (OR 15.1; 95% CI: 13.9-16.4; p <0.001) and non-cirrhotic patients (OR 48.8; 95% CI: 47.5-50.1; p <0.001). In the studied population, H. pylori was more commonly seen in the age between 50 and 64 years (49.4% vs 44.1%; p <0.0001), male (63.4% vs 59.9%; p <0.0413), African American (16.3% vs 10.6%; p <0.0001), and Hispanic (26.2% vs 14.9%; p <0.0001). H. pylori is more likely to be associated with complicated PUD hospitalizations (51.2% vs 44.2%; p <0.0067). Alcoholism and smoking were more common in H. pylori group compared to those without (43.6% vs 35.8%; p <0.0001 and 33.7% vs 24.8% p <0.0001, respectively). Factors associated with increased odds of H. pylori infection include African American (OR 2.3, 95% CI: 1.5-3.6), Hispanic (OR 2.6, 95% CI: 1.7-4.0), and smoking (OR 1.5, 95% CI: 1.1-2.2).

Conclusion: H. pylori are associated with PUD and concurrent cirrhosis, although it is less prevalent than general population. African American, Hispanic, and smoking were independently associated with increased odds of H. pylori infection. Further studies are required to better understand the epidemiology and confirm our findings.

Keywords: helicobacter pylori; live cirrhosis; peptic ulcer disease; population based study; prevalence study.