Prognostic value of serum pepsinogen isoenzymes in H. pylor eradication and other treatment modalities on the course of congestive gastropathy

ABSTRACT

Portal hypertensive gastropathy [PRG] is a common finding in patients with liver cirrhosis. Reduced gastric mucosal defense caused by H pylon may account for the pathogenesis of GI lesions in liver cirrhosis. Pepsinogens are secreted by chief cells in the fundus and body, The ratio of pepsinogen isozymes I and II in serum has good correlation with presence of metaplastic atrophic gastritis Most of the studies showed no relationship between H. pylon infection and congestive gastropathy in Fiver cirrhosis. The aim of this work is to estimate the prognostic value of serum levels of pepsinogen isoenzymes I and II and their ratio in addition to investigate the role and the eradication of H. pylon in the treatment of portal hypertensive gastropathy in comparison with other suggested treatments such as Daflon, sucralfait, propranolol and verapamil. Our intimate aim is to find .a simple treatment; if possible, for such common gastro-intestinal disease. This study included 64 cirrhotic patients divided into three groups Group I included 21 patients with congestive gastropathy and H. pylon infection and were treated with eradication therapy for H. pylon. Group 11 included 20 patients without H. pylon infection and without history of injection sclerotherapy are treated with sucralfait and Daflon. Group III 23 patients without H. pylon infection and with history of injection sclerotherapy are treated with propranolol and verapamil. Upper endoscopy and gastric biopsies for histopathology and H. pylon staining before and after treatment were done in all patients in addition to pepsinogen isoenzymes I and II, serology and other routine tests. The three types of therapy showed significant clinical improvement in these patients. Most of these patients are suffering from dyspeptic symptoms in the form of epigastric discomfort and pain after meals, flatulence and distension. This was more marked in patients with H pylon infection. Serum Pepsinogen I levels and PG I/lI ratio were significantly less in group I with H pylon infection than groups II and III [P<0.001]. There is substantial improvement after treatment in all patients that was most marked in patients of group I after eradication of H pylon. Serum Pepsinogen I levels and PG I/Il ratio in group I showed significant increase after eradication of H pylon [P<0.001]. PHG was improved significantly in all groups. Also, there were no differences in the response of PHG in the three groups. Comparison of the response of oesophageal varices to therapy between the three groups found that oesophageal varices improved significantly in group I in comparison to group II. It is concluded from this study that H pylon may aggravate this disease process as estimated by reduction of pepsinogen I level and PG I/lI ratio, and its eradication may be beneficial in patients with liver cirrhosis and portal hypertension, as estimated by normalization of pepsinogen level. Also, other treatment modalities were effective in decreasing the severity of this disease, which means that this disease process may be aggravated by other factors than H pylon