Dong Joon Kim, et al : H. pylori and Peptic Ulcer in Cirrhosis 17 (%) According to the presence of PU∥ without PU 76/218 (34.9%) with PU 24/70 (35.6%)¶ According to the etiology of cirrhosis HBV# 63/145 (43.4%) HCV** 9/24 (37.5%) HBV + HCV 2/5 (40.0%) Alcoholic 24/109 (22.0%)†† Cryptogenic 2/5 (40.0%) According to the Child-Pugh class A 53/103 (51.5%) B 32/105 (30.5%) C 16/80 (20.0%) Table 1. The prevalence of H. pylori infection in patients with liver cirrhosis, non-ulcer dyspepsia, and peptic ulcer disease LC* (n=288) 101/288 (35.1%)§ NUD† (n=322) 201/322 (62.4%) PUD‡ (n=339) 250/339 (73.7%) *Liver Cirrhosis, †Non-Ulcer Dyspepsia, ‡Peptic Ulcer Disease, ∥ Peptic Ulcer, # Hepatitis B Virus, **Hepatitis C Virus §p<0.001 (LC vs. NUD, LC vs. PUD), ¶p<0.001 (PU with LC vs. PU without LC), ††p<0.001 (alcohol vs. viral etiology) ulcer disease and H. pylori infection in patients with liver cirrhosis. We additionally evaluated the relationship between H. pylori infection and the etiology or severity of cirrhosis. MATERIALS AND METHODS The study population included 288 consecutive Korean patients (229 men and 59 women, 49.3±11.1 years of age) with newly diagnosed liver cirrhosis presenting at Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Chuncheon, Korea, between January 2000 and December 2004. 322 age- and sex-matched non-ulcer dyspepsia patients (259 men and 63 women, 49.0±10.0 years of age) without chronic liver disease were drawn to serve as a control group. Additionally, 339 age- and sex-matched peptic ulcer patients (272 men and 67 women, 48.1±11.5 years of age) without chronic liver disease were selected as a reference group. Those patients who had taken antibiotics, proton pump inhibitors, or non-steroidal anti-inflammatory drugs within 2 weeks before entry, and those patients who had a history of gastric surgery, were excluded. Liver cirrhosis was diagnosed using a combination of clinical, biochemical, radiologic, and histologic methods. The severity of cirrhosis was scored according to the Child-Pugh classification. Etiology of the cirrhosis was defined as alcoholic if viral markers (HBsAg, anti-HCV) were negative and there was a history of ethanol intake of over 60 g/day for 5 years or more. All the enrolled patients underwent upper gastrointestinal endoscopy with 4 biopsies taken from the antrum (within 2 cm from the pylorus) and 4 biopsies taken from the gastric body (greater curvature side of the midbody). Endoscopy was performed using an Olympus videoscope GIF 240 (Olympus Optical Co., Ltd., Tokyo, Japan). Endoscopic diagnosis of peptic ulcer disease was made when a distinct ulcer crater with fibrin-coated base larger than 5 mm was observed. The diagnosis of gastric ulcer was always confirmed by multiple biopsies of the ulcer. Four biopsy specimens 2 from the antrum and 2 from the gastric body were used to identify H. pylori, using the rapid urease test (CLOtestⓇ, Ballard Medical Products, UT, USA or ProntoDryⓇ, Medical Instruments Co., Herford, Germany). Four other specimens 2 from the antrum and 2 from the gastric body were used for determining H. pylori presence (hematoxylin-eosin & Wright-Giemsa staining). The presence of H. pylori infection was determined by positivity of rapid urease test and/or histology (Wright-Giemsa staining). This study was approved by the Hospital's Ethics Committee, and informed consent for endoscopy was obtained from all the patients. The demographic and clinical characteristics were analyzed statistically using the chi-square test and Spearman correlation test, as appropriate. A value of p<0.05 was considered to be statistically significant. Statistical calculation was made with the help of SPSS statistical package for Windows version 8.0.0. (SPSS Inc, Chicago, IL, USA).