Helicobacter pylori (HP) infection is common worldwide, but its influence on portal hypertension–related gastroduodenal lesions in cirrhotic patients remains uncertain. Upper gastrointestinal endoscopy (EGD) is essential for assessing mucosal injury and bleeding risk in this population.

Our aim was to determine the prevalence of HP infection in cirrhotic patients and evaluate its impact on the type and severity of endoscopic gastroduodenal lesions.

We conducted a retrospective study including all cirrhotic patients who underwent EGD with systematic gastric biopsies between January 2017 and August 2023. Patients were classified into two groups: HP-negative (GA) and HP-positive (GB). Endoscopic findings—including esophageal varices, gastric varices, portal hypertensive gastropathy (PHG), and congestive, erosive, or ulcerative gastroduodenal lesions—were compared between groups.

A total of 127 patients were included (mean age 61 years, sex ratio 1.49). HP infection was detected in 54% of patients. The most frequent endoscopic findings were esophageal varices (100%), gastric varices (14%), PHG (32%), congestive gastropathy (51%), ulcerated lesions (39%), nodular lesions (13%), and gastroduodenal ulcer (25%).Comparison between the two groups showed no significant difference in the prevalence or severity of endoscopic lesions, including PHG (31% vs 33.3%; p = 0.783), ulcerated lesions (34.5% vs 42%; p = 0.384), and gastroduodenal ulcer (29.3% vs 21.7%; p = 0.328). HP status was not associated with the grade or type of portal hypertension–related lesions.

HP infection is frequent among cirrhotic patients but does not appear to influence the type or severity of gastroduodenal or portal hypertension–related endoscopic lesions. However, given its high prevalence and potential role in mucosal fragility, systematic HP screening and eradication may still offer clinical benefit and should be considered as part of comprehensive cirrhosis management.