The Effects of Helicobacter pylori on the Treatment Outcomes of Peptic Ulcer in Patients with Liver Cirrhosis: A Systematic Review and Network Meta-Analysis

TL;DR

This study examines whether eradicating Helicobacter pylori improves peptic ulcer treatment outcomes in patients with liver cirrhosis.

Contribution

A network meta-analysis comparing treatment outcomes of peptic ulcers in cirrhotic patients based on H. pylori infection status.

Findings

No significant difference in unhealed or recurrent peptic ulcers across H. pylori groups.

The Hp_Erad group had the highest SUCRA values for ulcer healing and recurrence prevention.

Findings highlight an evidence gap rather than definitive conclusions due to low-quality evidence.

Abstract

Background/Objectives: Helicobacter pylori (H. pylori) positivity is associated with peptic ulcers in the general population. However, its role in peptic ulcers in cirrhotic patients remains controversial. The impact of H. pylori infection status on the treatment outcomes of peptic ulcers in liver cirrhosis was investigated. Methods: A systematic review and network meta-analysis was performed. The following databases were searched: Ovid MEDLINE, PubMed, Web of Science, CQVIP, Wanfang, China National Knowledge Infrastructure, chictr.org.cn, and ClinicalTrials.gov. Relevant studies were published up to 31 December 2025. Studies comparing the treatment outcomes of peptic ulcers in liver cirrhosis were included. Patients were divided into three groups: Hp_pos group (including those who failed to eradicate H. pylori and who denied eradication therapy), Hp_neg group (H. pylori-uninfected individuals), and Hp_Erad group (H. pylori tested positive at baseline but was successfully eradicated afterwards). Prospero registration number: CRD42024551260. Results: Four prospective studies were eligible. No significant difference was found in the unhealed peptic ulcers or recurrent peptic ulcers, although the Hp_Erad group had the highest values of the surface under the cumulative ranking curve (SUCRA) [(0.773, mean rank: 1.5) and (0.809, mean rank: 1.4), respectively]. Conclusions: Based on the available low-quality evidence, this network meta-analysis did not detect a statistically significant benefit of H. pylori eradication for ulcer healing or recurrence prevention in cirrhotic patients. These findings should be interpreted as highlighting an evidence gap rather than providing definitive evidence. Further randomized controlled trials are necessary to confirm these findings. Clinical decisions regarding H. pylori eradication in cirrhotic patients should be made carefully, weighing the potential benefits against the risks.

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