Epidemiology of Peptic Ulcer Disease in Cirrhotic Patients: Role of Helicobacter pylori Infection X. Calvet, M. Navarro, M. Gil, A. Lafont, I. Sanfeliu, E. Brullet, R. Campo, B. Dalmau, E. Rivero, and P. Mas Departments of Internal Medicine, Microbiology, and Epidemiology, and Endoscopy Unit, Consorci Hospitalari del Parc Taulı ´, Sabadell, Barcelona, Spain Objective: The aim of this study was to investigate the clinical and epidemiological factors associated with the appearance of peptic ulcer in patients with cirrhosis and, in particular, the role of Helicobacter pylori infection. Methods: A total of 201 of 220 consecutive patients in- cluded in a prospective study that aimed to evaluate the effect of dietary intervention on cirrhotic complications and survival underwent upper gastrointestinal endos- copy. At entry, an epidemiological and clinical question- naire was completed and the presence of peptic ulcer disease or esophageal varices at endoscopy was prospec- tively collected. Sera were obtained and stored at 70°C until analyzed, being tested afterward for Helicobacter pylori antibodies using a commercial ELISA kit. Results: Eleven of 201 patients had borderline anti-Helicobacter pylori IgG titers and were excluded from further anal- ysis. In the remaining 190 patients, point prevalence of peptic ulcer was 10.5% and lifetime prevalence 24.7%. Multivariate analysis selected male sex (OR 2.3; 95%CI 1.09 – 4.89) and Helicobacter pylori seropositivity (OR: 1.7, 95%CI 1.02–2.81) as the variables independently related to peptic ulcer disease. Conclusions: Male sex and seropositivity for Helicobacter pylori are the major risk factors for peptic ulcer in cirrhosis. (Am J Gastro- enterol 1998;93:2501–2507. © 1998 by Am. Coll. of Gas- troenterology) INTRODUCTION Current evidence strongly suggests that gastric Helico- bacter pylori infection is the major pathogenic factor for peptic ulcer disease in the general population. Successful eradication of Helicobacter pylori has been shown to dra- matically reduce the risk of peptic ulcer recurrence (1–5). Although the prevalence of peptic ulcer is high in cir- rhotic patients, reaching a point prevalence of 11.7% (6), few data are available concerning the clinical and epidemi- ological factors related to the appearance of peptic ulcer in cirrhosis. In particular, the role of Helicobacter pylori in- fection in cirrhotic patients remains controversial, as many recent studies have not found a relationship between Heli- cobacter pylori infection and peptic ulcer in cirrhosis (7–9). The aim of the present study was, therefore, to investigate the factors related to the appearance of a peptic ulcer in patients with cirrhosis, with special attention to the role of Helicobacter pylori infection. MATERIALS AND METHODS Patients A total of 220 of 351 consecutive cirrhotic patients seen at the Hospital de Sabadell between January 1991 and December 1994 were included in a study that aimed to investigate the effect of nutritional counseling on the out- come of cirrhosis (10). The other 131 patients were ex- cluded for the following reasons: age 70 yr (52 patients), previous diagnosis of hepatocellular carcinoma or other neoplasm (17 patients), refusal to participate in the study (41 patients), early death (14 patients), or other causes (seven patients). At the time of inclusion, a questionnaire was completed and patient serum was obtained and stored at -70°C until analyzed. The most relevant epidemiological and clinical data collected were: age, sex, educational level (defined as lack of schooling, elementary or medium-high schooling), current smoking, alcohol consumption (mea- sured as current or past ethanol intake, estimated grams per week and years of ethanol consumption), etiology of the cirrhosis, and self-reported history of diabetes mellitus, chronic obstructive pulmonary disease, peptic ulcer disease, previous ulcer surgery, and current treatment, including H2-blockers and omeprazole. Child-Pugh score (11) was calculated at entry. Etiology of the cirrhosis was defined as viral if HBsAg or antibodies to the hepatitis C virus were present, and as alcoholic when viral markers were negative and patients had a history of daily ethanol intake 80 g/day for 5 yr. Less frequently occurring diseases such as hemo- chromatosis or primary biliary cirrhosis were diagnosed according to the current clinical criteria. Cryptogenetic cir- rhosis was diagnosed when etiologic study was negative. The epidemiological factors related to Helicobacter pylori infection in this series have been reported elsewhere (12). An upper gastrointestinal endoscopy was proposed for investigation of gastroesophageal varices, and 186 patients Received Oct. 15, 1997; accepted Aug. 28, 1998. THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 93, No. 12, 1998 Copyright © 1998 by Am. Coll. of Gastroenterology ISSN 0002-9270/98/$19.00 Published by Elsevier Science Inc. PII S0002-9270(98)00592-9 2501