Association of H Pylori Infection to Variceal Hemorrhage in Cirrhotic Patients

Objective: To investigate the association between Helicobacter pylori infection and variceal hemorrhage in cirrhotic patients. Methods: A case–control study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad, over six months. A total of 210 cirrhotic patients were recruited, comprising 105 with variceal hemorrhage (cases) and 105 without hemorrhage (controls). H. pylori infection was diagnosed using stool antigen testing. Demographic, clinical, biochemical, and endoscopic parameters were recorded. Continuous variables were compared using ANOVA, and categorical variables with Chi-square or Fisher’s exact tests. Logistic regression was applied to adjust for potential confounders. Results: The mean age of patients was 43.6 ± 15.4 years, with a nearly equal gender distribution. The majority of patients had Child-Pugh class A (40%), followed by B (35.2%) and C (23.8%). H. pylori positivity was significantly higher in bleeding patients compared with non-bleeding patients (65.6% vs. 43.6%; p=0.004). Cases also had significantly higher BMI (p=0.002), prolonged PT (p=0.005), elevated INR (p=0.013), and lower blood pressures (p<0.001) compared with controls. Esophageal variceal grade II–III was strongly associated with bleeding (p<0.001). Child-Pugh class and hepatitis status did not significantly differ between groups. Conclusion: H. pylori infection was significantly associated with variceal hemorrhage in cirrhotic patients, independent of underlying hepatitis status and Child-Pugh class. Along with variceal grade and coagulation profile, H. pylori may serve as an additional predictor of bleeding risk.