Targeting Helicobacter pylori in liver-impaired populations: a systematic review of efficacy and safety

Liver impairment can alter the metabolic capacity of the organ significantly, potentially affecting the efficacy and safety of Helicobacter pylori (H. pylori) eradication regimens. Although this issue is highly significant, no standardized guidelines currently exist for H. pylori eradication therapy in patients with liver dysfunction. To bridge this gap, we systematically reviewed studies on the efficacy and safety of H. pylori eradication therapy in individuals with liver impairment. The systematic review included a search of PubMed, the Igaku Chuo Zasshi, and the Cochrane Library database to identify eligible randomized controlled trials (RCTs) and/or non-randomized controlled trials (NRCTs). Three RCTs and five NRCTs were included. Research on the effectiveness of H. pylori eradication treatment in patients with and without liver disease has produced inconsistent findings, with a study reporting higher eradication rates in the liver disease group, and others finding no significant difference, leaving no definitive consensus. Two studies reported eradication rates <70% in patients with HCV infection, whereas other studies demonstrated eradication rates >80% in groups with liver impairment. Furthermore, even in cases of advanced liver impairment such as non-alcoholic steatohepatitis (NASH) or liver cirrhosis, eradication rates did not decline, and adverse events were either minimal or comparable with those observed in groups without liver impairment. H. pylori eradication therapy is applicable and safe for patients with liver disease; however, treatment indications should be determined carefully by considering reduced hepatic metabolic capacity and specific indications for eradication, while remaining vigilant for potential adverse effects.