18 The Korean Journal of Internal Medicine : Vol. 23, No. 1, March 2008 A B Figure 1. The prevalence of peptic ulcer (A) and H. pylori infection (B) in patients with liver cirrhosis. (A) The prevalence of peptic ulcer disease in cirrhotic patients is not significantly different according to Child-Pugh class (p>0.05). (B) A negative correlation is demonstrated between the prevalence of H. pylori infection and the severity of liver cirrhosis according to Child-Pugh class (Spearman's rho=-0.267, p<0.001). RESULTS The etiologies of the 288 cirrhosis patients were: Hepatitis B virus (HBV)-related in 145, Hepatitis C virus (HCV)-related in 24, HBV and HCV-related in 5, alcohol-related in 109, and cryptogenic in 5 patients. The prevalence of H. pylori infection in patients with cirrhosis, patients with non-ulcer dyspepsia without chronic liver disease, and peptic ulcer disease patients without chronic liver disease, were 35.1% (101/288), 62.4% (201/322), and 73.7% (250/339), respectively. The prevalence of H. pylori infection in patients with cirrhosis was significantly lower than in non-ulcer dyspepsia (p <0.001) or peptic ulcer disease patients without chronic liver disease (p <0.001) (Table 1). The point prevalence of peptic ulcer disease in patients with cirrhosis was 24.3% (36 gastric ulcer, 31 duodenal ulcer, 3 gastric and duodenal ulcer). The prevalence of H. pylori infection was 35.6% in peptic ulcer disease patients with liver cirrhosis and 73.7% in peptic ulcer disease patients without chronic liver diseases (p <0.001). The prevalence of H. pylori infection did not differ in patients with liver cirrhosis, whether peptic ulcer was present (35.6%) or no (34.9%) (p >0.05) (Table 1). The prevalence of H. pylori infection in patients with HBV-related, HCV-related, HBV- and HCV-related, alcohol- related, and cryptogenic liver cirrhosis was 43.4%, 37.5%, 40.0%, 22.0%, and 40.0%, respectively. The prevalence of H. pylori infection in patients with hepatitis virus-related liver cirrhosis (42.5%) was significantly higher than that in patients with alcohol-related liver cirrhosis (22.0%, p <0.001) (Table 1). As shown in Table 1, the prevalence of H. pylori infection in patients with Child-Pugh class A, B, and C liver cirrhosis was 51.5%, 30.5%, and 20.0%, respectively. A negative correlation was noted between the prevalence of H. pylori infection and the severity of liver cirrhosis according to Child-Pugh class (Spearman's rho=-0.267, p <0.001). The prevalence of peptic ulcer disease in cirrhotic patients according to Child-Pugh class A, B, and C was 22.3%, 21.0%, and 31.3%, respectively (p >0.05) (Figure 1). DISCUSSION Although the point prevalence of peptic ulcer disease in patients with liver cirrhosis is high, reaching 24.3%, the exact mechanism remains to be determined. The high prevalence of peptic ulcer disease in patients in our study with liver cirrhosis is consistent with previous reports1-3, 6-8). The role of H. pylori infection in the pathogenesis of peptic ulcer disease has been extensively evaluated in non-cirrhotic patients4, 5). The increased rate of peptic ulcer disease in patients with cirrhosis has been explained in some studies, by higher rates of gastric colonization with H. pylori 6, 7, 14-18, 23, 24). However, other studies have found no relationship between H. pylori infection and peptic ulcer disease in cirrhosis9-12, 18-20). For a proper interpretation of the studies investigating the prevalence of H. pylori infection in patients with liver cirrhosis, several factors, such as diagnostic methods, etiology of liver cirrhosis, and geographic and racial differences in H. pylori prevalence should be considered. In our study, the prevalence of H. pylori infection in patients with liver cirrhosis was 35.1%. Previous studies have reported a wide range (39～89%) in the prevalence of H. pylori infection in