Upper endoscopic changes and colonization of the gastric mucosa by helicobacter pylori in schistosomal portal hypertension

ABSTRACT

In this study, two patient groups with schistosomal hypertension and a control group were examined endoscopically and colonization of the gastric mucosa by H. pylori was estimated. Each group comprised 60 persons. The two patient groups were defined as having portal hypertension by the presence of oesophageal varices. Group II were having a history of bleeding [Haematemesis or melena]. A modified classification for oesophageal varices [O.V.] was made. O.V. of the high grades were more prevalent in group II with history of bleeding [35 percent vs. 70 percent]. There was positive correlation between O.V., G.V. and the degree of gastritis. Gastric changes were classified into mild gastritis, severe gastritis or gastric atrophy. Severe gastritis was more common in group II. This suggests that these lesions could be another source of bleeding in group II in addition to the more advanced grades of O.V. H. pylori was detected in the antral mucosa by two methods, the CLO [urease] test and microscopic detection of the typical organism in Giemsa stained gastric biopsies. 60 percent of group I and 85 percent of group II were positive compared to 33.3 percent of the control group. The differences between the patient groups and the control were highly significant. However, considering the patients having gastritis only in all groups, the difference was not significant. There was a positive correlation between H. pylori and the severity of gastritis. These results suggest that gastric changes resulting from the vascular and hormonal changes that could be produced by portal hypertension may facilitate colonization with H. pylori. The latter could enhance gastritis and hence chronicity or bleeding. A possible answer could be obtained if H.pylori is eradicated then the endoscopy is repeated