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Does H. pylori eradication therapy benefit patients with hepatic encephalopathy?: systematic review
Christian Schulz1, Kerstin Schütte, Peter Malfertheiner
1Department of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University of Magdeburg, Magdeburg, Germany.
Background:
Ammonia is considered to play a central role in the pathogenesis of (minimal) hepatic encephalopathy ((M)HE). Bacterial urease activity is the regulatory enzyme, and bacteria colonizing the colon were originally assumed to be the main source of urease activity. Current concepts of the pathogenesis of (M)HE focus, among other things, on ammonia, which is generated both by urease activity of intestinal bacteria and by Helicobacter pylori in the stomach.
Aim:
: The aim of this study was to provide a systematic review of the role of H. pylori in the pathogenesis of HE.
Methods:
A systematic review was conducted following the recommendations in the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement with a database search in PubMed, Scopus, and the Cochrane Database for all original contributions published from January 1950 to December 2013. As search terms in title and abstract, the following combinations were used: hepatic encephalopathy AND Helicobacter pylori, HE AND Helicobacter pylori, MHE AND Helicobacter pylori, hyperammonemia AND Helicobacter pylori, and minimal hepatic encephalopathy AND Helicobacter pylori, with a language restriction to English and German.
Results:
Observational studies revealed conflicting results concerning a possible role of H. pylori infection in the pathogenesis of HE. Thirteen prospective clinical trials assessed the effect of H. pylori eradication in patients with HE and liver cirrhosis. Seven of these showed a beneficial effect of eradication therapy on (M)HE. All of these studies were highly diverse in design and methodology.
Conclusions:
Eradication therapy in H. pylori-positive cirrhotic patients may have a beneficial influence on hyperammonemia and (M)HE, but evidence from well-designed clinical studies is weak.
Insights
Helicobacter pylori eradication may benefit patients with hepatic encephalopathy (HE), particularly those with liver cirrhosis. However, current evidence is limited, necessitating further well-designed studies to confirm its role in managing hyperammonemia and (M)HE.
Area of Science:
- Hepatology
- Gastroenterology
- Microbiology
Background:
- Ammonia plays a key role in hepatic encephalopathy (HE) pathogenesis.
- Bacterial urease activity, including from Helicobacter pylori (H. pylori) in the stomach, contributes to ammonia production.
- Intestinal bacteria were historically considered the primary source of urease activity in HE.
Purpose of the Study:
- To systematically review the role of H. pylori in the pathogenesis of hepatic encephalopathy (HE).
- To evaluate the impact of H. pylori eradication on HE and hyperammonemia.
Main Methods:
- Systematic review following PRISMA guidelines.
- Database searches in PubMed, Scopus, and Cochrane Library (1950-2013).
- Search terms included "hepatic encephalopathy" AND "Helicobacter pylori" and related terms in English and German.
Main Results:
- Observational studies showed conflicting results regarding H. pylori's role in HE.
- Thirteen prospective trials on H. pylori eradication in HE patients with liver cirrhosis were analyzed.
- Seven trials indicated a potential benefit of eradication therapy on (M)HE, but study designs were diverse.
Conclusions:
- H. pylori eradication may positively influence hyperammonemia and (M)HE in cirrhotic patients.
- The current evidence supporting this benefit is weak due to a lack of well-designed clinical studies.
- Further rigorous research is needed to establish the definitive role of H. pylori in HE pathogenesis and treatment.
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