BACKGROUND: It is common for the gastroendoscopist to find patients infected simultaneously with hepatitis B virus (HBV) and Helicobacter pylori (H pylori). Considering that HBV infection is linked to hepatocellular carcinoma and H pylori to gastric cancer, we investigated the incidence in this kind of patients in the northern Jiangsu Province, China. Rational management of these patients was also discussed.
METHODS: Seventy-two patients including 28 patients with chronic hepatitis B and 44 patients with post hepatitis B liver cirrhosis served as observation group. Thirty patients with gastritis but without liver disease were included as controls. Diagnostic endoscopy was performed in all the patients. Three biopsy specimens were taken from the pyloric antrum 3 cm from the pyloric ring. Urease test staining of hematoxylin and eosin or fuchsin, and immunohistochemical analysis of H pylori IgG antigen and HBV antigen (HBsAg, HBcAg) were performed.
RESULTS: The extent and intensity of chronic inflammation were identified in 95.5% (42/44) of the antrum mucosa of the patients with cirrhosis and in 92.9% (26/28) of the patients with chronic hepatitis. The expression of H pylori in the mucosa was found in 29 of the 42 patients with cirrhosis associated with antrum inflammation (69.0%). The expression of H pylori was observed in 20 of the 26 patients with chronic hepatitis combined with antrum inflammation (76.9%). No significant difference existed between the cirrhosis group and the chronic hepatitis group. The rates of HBV antigen expression in the H pylori positive and negative gastric antrum mucosa were 69.8% (37/53)and 73.7% (14/19), respectively (P>0.05).
CONCLUSIONS: Over-expression of HBV antigen (HBsAg and HBcAg) coexists with the expression of H pylori antigen in the H pylori infected gastric mucosa. Difficult clearance of HBsAg and HBcAg from gastric epithelial cells may be related to persistent H pylori infection. Early treatment of H pylori infection may be beneficial to the prognosis of patients with chronic liver disease.