Expression of hepatitis B virus antigen and Helicobacter pylori infection in gastric mucosa of patients with chronic liver disease

BACKGROUND: It is common for the gastroendoscopist to find patients infected simultaneously with hepatitis B vi- rus (HBV) and Helicobacter pylori (H pylori). Considering that HBV infection is linked to hepatocellular carcinoma and Hpylori 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 dis- cussed. 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 pa- tients 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 py- loric antrum 3 cm from the pyloric ring. Urease test stain- ing of hematoxylin and eosin or fuchsin, and immunohisto- chemical analysis of H pylori IgG antigen and HBV antigen (HBsAg, HBcAg) were performed. RESULTS: The extent and intensity of chronic inflamma- tion were identified in 95.5% (42/44) of the antrum muco- sa 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 cir- rhosis 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 cir- rhosis group and the chronic hepatitis group. The rates of HBV antigen expression in the H pylori positive and nega- tive 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 anti- gen in the H pylori infected gastric mucosa. Difficult clea- rance of HBsAg and HBcAg from gastric epithelial cellsmay be related to persistent H pylori infection. Early treat- ment of H pylori infection may be beneficial to the progno- sis of patients with chronic liver disease.