Evaluation of Helicobacter pylori diagnostic methods in patients with liver cirrhosis X. CALVET*, I. SANFELIU  , E. MUSULEN à , P. MAS§, B. DALMAU*, M. GIL*, M. R. BELLA à , R. CAMPO*, E. BRULLET*, C. VALERO* & J. PUIG – *Digestive Diseases Unit,  Microbiology Unit, àPathology Department, §Internal Medicine Service and –Radiology Department, Corporacio ´ Parc Taulı ´, Sabadell, Barcelona, Spain Accepted for publication 11 March 2002 SUMMARY Background: Helicobacter pylori-associated peptic ulcer is a frequent complication in cirrhotic patients and its morbidity rate is high. In spite of this, diagnostic methods for H. pylori infection have not been fully evaluated in these patients. Aim: To evaluate H. pylori diagnostic methods in patients with liver cirrhosis. Methods: One hundred and one cirrhotic patients were included in the study. Three antral and two corpus biopsies were obtained for rapid urease test of the antral mucosa, and Giemsa stain and immunohistochemistry were performed for both the corpus and antrum. Serology, 13 C-urea breath test and faecal H. pylori antigen determination were also carried out. Results: Sixty-two patients were positive and 35 were negative for H. pylori infection; four were indeterminate. The sensitivity and specificity were 90.4% and 100%, respectively, for antral histology, 100% and 100% for gastric body histology, 90.4% and 100% for antral immu- nohistochemistry, 96.2% and 96.7% for body immuno- chemistry, 85.7% and 97% for rapid urease test, 83.6% and 55.9% for serology, 96.4% and 97.1% for 13 C-urea breath test and 75.4% and 94.1% for faecal antigen. Conclusion: The most reliable tests for H. pylori infection in cirrhotic patients were the 13 C-urea breath test and gastric body histology. INTRODUCTION Peptic ulcer is a frequent finding in cirrhotics. The morbidity and mortality of ulcer complications have been shown to be very high in these patients. Helicobacter pylori infection is the major cause of peptic ulcer in cirrhosis, as it is in the general population. 1–3 The eradication of H. pylori infection in ulcer patients leads to nearly total prevention of subsequent peptic ulcer and its complications. 4–7 H. pylori infection may also play a role in increasing the risk of hepatic encephalopathy, although this topic remains extremely controversial. 8–12 Therefore, the correct diagnosis and treatment of H. pylori infection is an important preventive and therapeutic measure in patients with liver cirrhosis. Cirrhotic patients have humoral and gastric mucosal changes that may affect the diagnostic methods used to identify H. pylori infection. In addition, changes in the synthesis of antibodies and hypergammaglobulinaemia may affect the reliability of serology, as reported elsewhere. 13–15 The objective of this study was to evaluate the reliability of the diagnostic methods for H. pylori infection in patients with liver cirrhosis. PATIENTS AND METHODS Between September 1998 and June 2000, 101 con- secutive cirrhotic patients were enrolled in the study. Ó 2002 Blackwell Science Ltd 1283 Correspondence to: Dr X. Calvet, Unitat de Malalties Digestives, Corporacio ´ Parc Taulı ´, Parc Taulı ´, s ⁄ n, 08208 Sabadell, Barcelona, Spain. E-mail: xcalvet@cspt.es Aliment Pharmacol Ther 2002; 16: 1283–1289.