HISTOLOGICALLY DIAGNOSED HELICOBACTER-PYLORI IN HEART-TRANSPLANT RECIPIENTS

Background: The role of Helicobacter pylori in the pathogenesis of non autoimmune gastritis and peptic ulceration is well recognized. H. pylo ri is widely prevalent in the general population, but the incidence am ong heart transplant recipients has not been reported. Furthermore, th e natural history of this infection may be modified by immunosuppressi on. Methods: Gastric and duodenal biopsy specimens from 47 heart trans plant recipients were examined over a period of 44 months. Results: Tw enty-three (49%) patients had H. pylori infection (15 men, 8 women; me an age 49 [range 35 to 59] years). Eight of the 23 (35%) had symptoms. These eight patients were treated for H. pylori with bismuth, metroni dazole, and amoxicillin, followed by maintenance H-2-receptor antagoni sts. Dyspepsia continued in six of these patients, with persistence or recurrence of H. pylori being demonstrated in four. Conclusions: This study shows that although histologically diagnosed H. pylori infectio n is widely prevalent among heart transplant recipients, this prevalen ce is very similar to the general population. Immunosuppression may pl ay a role in the recurrence or persistence of this infection and may d iminish the mucosal inflammatory response to the organism.