[Study of correlation between Helicobacter pylori infection and hyperammonemia and hepatic encephalopathy in...

To evaluate the relationship among helicobacter pylori (HP) infection, blood ammonia concentrations, and hepatic encephalopathy (HE) status, and to investigate the effect of HP eradication on blood ammonia levels and HE status in cirrhotic patients.

Three hundred and sixty-eight cirrhotic patients were enrolled. Patients were evaluated for the demographic profile, number connection test (NCT), HP infection, Child-Pugh degree of liver dysfunction, blood ammonia concentration and status of mentation. Patients with HP infection were given one week therapy with omeprazole plus clarithromycin and amoxicillin. (13)C urea breath test was performed, and the mental symptoms and blood ammonia levels were reassessed after the eradication therapy.

(1) The overall HP infection rate was 70.1% (258/368 cases), and HE positive in 51.4%(189/368 cases). Subclinical hepatic encephalopathy (SHE) was diagnosed in 85 out of 19(47.5%) cirrhotics patients. (2) Blood ammonia concentrations in HP negative and HP positive cirrhotics were (52.7+/-49.8)micromol/L and (79.3+/-61.8)micromol/L, respectively (P<0.01), and it was significantly reduced to (52.6+/-36.5) micromol/L after HP eradication therapy (P<0.01). HE was more frequently found in patients with HP infection than without it (59.6% vs. 31.8%, P<0.01). HE rate were significantly dropped to 32.8% after HP eradication (P<0.01). (3)HP prevalence rate was significantly different among cirrhotics with HE (81.5%),those with SHE (68.5%), or without HE (53.9%)(P<0.05). The level of blood ammonia had significantly difference among the cirrhotics with HE [(96.6+/-78.2)micromol/L], those with SHE [(60.5+/-50.4)micromol/L], or without HE[(46.8+/-36.4)micromol/L, both P<0.05].

HP infection aggravates elevated blood ammonia concentration and hepatic encephalopathy in cirrhotic patients. HP eradication may be helpful in the treatment and prevention of HE in cirrhotic patients.