Madam,
A high prevalence of helicobacter pylon (HP) colonization has been found in portal hypertension, especially in those with gastric erosions¹. Alternately congestive gastropathy is also a frequent endoscopic finding in patients with portal hypertension^2-4. Endos copically it is difficult to differentiate the redness of HP related gastritis from that of portal hypertensive gastropathy but histologically^3,4 the two conditions are quite distinct and so is their treatment We studied endoscopic appearances of gastric mucosae in 26 patients with endoscopically confirmed oesphageal varices and took two antral biopsies from each subject to look for HP colonization both on CLO testing and histology. Of 26 portal hypertensives studied (19 cirrhosis and 7 IPH) moderate to severe gastritis was found in 19 cases (73%), while 7 had associated duodenal ulcer. The distribution of gastnitis, ulcer and H. pylori in the two groups is shown in the Table.

All cases with gastnitis showed evidence of HP colonization. Five unselected patients were treated with bismuth salts to eradicate HP. Following treatment HP cleared and histology became negative in 3 but their endoscopic findings remained unchanged. Childs grading showed no correlation to gastritis. Present study suggests that gastritis of portal hypertension is not actually due to HP colonization but is secondary to congestion and vascular ectasia^3-5; because although majority of cases showed HP colonization which responded to treatment but endoscopic ap­pearances of the mucosae remained unchanged. Similar findings were reported by McCOrmick et al⁶.

Huma Quresbi
Waquaruddin Ahmed JavedKazi* SarwarJ. Zuberi
PMRC Research Centre and BMSI (Patb)*, Jinnab PostgraduateMedical Centre, Karachi.

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