Helicobacter pylori versus platelet-to-spleen ratio as a risk factor for variceal bleeding in patients with liver-cirrhosis-related portal hypertension

Background Acute upper gastrointestinal (GIT) bleeding is a common medical emergency clinically manifested by hematemesis and/or melena. This study aimed to elucidate the roles of Helicobacter pylori and the platelet-spleen ratio as risk factors for variceal bleeding in patients with portal hypertension secondary to liver cirrhosis. Methods The study was conducted on 200 patients with liver cirrhosis of various etiologies who were divided into two groups: group 1 included 100 patients with liver cirrhosis and portal hypertension with or without a history of upper GIT bleeding, and group 2 included 100 patients with liver cirrhosis without portal hypertension. Upper GIT endoscopy was performed, and biopsy samples were taken from the gastric antral mucosa for rapid urease testing. The platelet-spleen diameter ratio was calculated for all patients. Results In group 1, most patients who had a history of variceal bleeding were H. pylori-negative whereas most patients without a history of variceal bleeding were H. pylori-positive, implying that H. pylori may play a significant role as a protective factor against variceal bleeding. The calculated odds ratio for the rapid urease test was low (0.851), whereas the calculated odds ratio for the platelet-spleen diameter ratio was higher (9.766) than that for the rapid urease test. Thus, the rapid urease test plays a significantly higher role than the platelet-spleen ratio as a risk factor for bleeding (p-value = 0.001). Conclusions H. pylori has a more significant relationship with upper GIT bleeding than the platelet-spleen diameter ratio.