Study of Prevalence of Helicobacter Pylori Infection and its Impact on GIT Bleeding in Patients with Hemophilia and von Willibrand Disease

Abstract

Helicobacter pylori has been clearly recognized as the main cause of gastritis and most cases of peptic ulcer, and it has also been implicated in the pathogenesis of gastric adeno-carcinoma and mucosa-associated lymphoid tissue lymphoma (MALT). Infection with Helicobacter pylori is the main etiological factor for erosive gastritis and duodenal or gastric peptic ulcers often complicated with life-threatening bleeding in patients with coagulation disorders. We prospectively investigated the prevalence of H. pylori infection in patients with hemophilia A or B or von Willebrand syndrome. This is a case control study. All participants were male patients above 12 years ‎visiting the hematology clinic of Kasr Al Aini hospital and ‎the Egyptian society of Hemophilia. The study received REC approval from Kasr Al Aini ‎medical school and all participants gave written consents. Forty male patients with bleeding disorders with age range from 12 years to 52 years (mean age 24) categorized as: - 30 patients with Hemophilia A (75% of cases) - 6 patients with Hemophilia B (15% of cases) - 4 patients with WND (10% of cases) Exclusion criteria: • Patient who received triple therapy before. • Patients with liver cirrhosis, thrombocytopenia, any platelet or vascular defects. • Patient with peptic ulcer disease. The control group included 20 normal male subjects with age range from 14 years to 46 years (mean age 27) with no history of bleeding or easy bruising of the same exclusion criteria of the patients included in the study. And the same socioeconomic level determined by structured questionnaire that considered the residence neighborhood, water supply, type of house, number of rooms in the house, number of persons in each room, income, and educational level. Each patient and control subject in the study were tested one time for H. pylori stool antigen by ELISA, This technique is non-invasive, rapid, easy-to-use, and shows good performance characteristics for diagnosis of H. pylori infections, with sensitivity, specificity, PPV, NPV, and efficiency were 100%, 90.0%, 96.9%, 100%, and 97.6% respectively. All patients and control subjects were tested for occult blood using guaiac-based fecal occult blood test. The negative results were confirmed by another two negative samples from the same patient at separate days. 28 out of 40 patients were H. pylori positive (70%); and 12 out of 20 control subjects were H. pylori positive (60%). Among 28 H.pylori positive patients, 5 patients tested positive for occult blood (17.9 %), all patients who are positive for occult blood are positive for H. pylori stool antigen. Among the 12 H.pylori positive subjects ‎ in the‎ control group, only one tested positive for occult blood (8.3%). None of the H. pylori negative patients or control subjects had a positive occult blood disease. No significant difference between prevalence of H. pylori among hemophilia and VWD patients (70 %) n=40 and its prevalence among normal control subjects (60 %) n=20, the odds ratio is ‎‎1.55, 95% CI (0.6162 to 3.9269), z statistic 0.935, ‎Significance level P = 0.3497. While the odds ratio of H. pylori infection in patients in relation ‎to controls is about 1.5; It is higher for occult ‎bleeding detected by FOBT in absence of history of frank ‎bleeding; Odds ratio: 2.39, 95% Confidence Interval: 0.2485 to ‎‎23.0104, z statistic: 0.755, Significance level: P= 0.4504. We concluded that in patients with hemophilia, H. pylori should be considered as an important cause of GI bleeding. The recurrence of the infection and GI bleeding can be prevented with eradication of H. pylori. Screening test for H. pylori would be needed in patients with hemophilia in endemic areas.