title: Helicobacter pylori infection does not correlate with plasma ammonia concentration and hepatic encephalopathy in patients with cirrhosis.
abstract: OBJECTIVE
  In patients with cirrhosis, infection of the stomach with Helicobacter pylori may increase ammonia production and, consequently, the incidence of hepatic encephalopathy. To test this hypothesis a retrospective analysis was performed in patients with a transjugular intrahepatic portosystemic shunt. These patients are regarded to be ideal candidates for such a study since they have a high bioavailability of gut-derived ammonia and many of them develop spontaneous hepatic encephalopathy.
  
  
  METHODS
  In 132 patients (Child-Pugh class A: 24%, B: 49%, C: 27%) with stable transjugular intrahepatic portosystemic shunt function for more than 3 months (mean follow-up: 15.5 +/- 10.8 months) the diagnosis of H. pylori infection was established by a specific and sensitive immunoblot assay for IgG- and IgA-antibodies. During follow-up, hepatic encephalopathy was assessed by clinical examination and a structured questionnaire. Venous plasma ammonia concentration was measured at the time of antibody determination (end of study period).
  
  
  RESULTS
  Eighty-four patients (64%) had negative and 48 patients (36%) had positive immunoblots for H. pylori. The groups were comparable with respect to age, gender, etiology of cirrhosis, Child-Pugh class, follow-up after transjugular intrahepatic portosystemic shunt, and shunt function. The ammonia concentrations of the patients without (group 1) and with antibodies against H. pylori (group 2) were 73 +/- 27 and 69 +/- 28 mumol/L (mean +/- SD), respectively. Hepatic encephalopathy occurred in 23 of 84 patients (27%) of group 1 and in 11 of 48 patients (23%) of group 2.
  
  
  CONCLUSIONS
  A positive immunoblot for H. pylori antibodies neither correlates with plasma ammonia concentration nor with the incidence of hepatic encephalopathy in patients with cirrhosis of the liver and portosystemic shunt.
authors.affiliation: Department of Gastroenterology and Hepatology, Albert Ludwigs University School of Medicine, D-79106 Freiburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Huber
authors.forename: M
authors.initials: M
authors.lastname: Rössle
authors.forename: V
authors.initials: V
authors.lastname: Siegerstetter
authors.forename: A
authors.initials: A
authors.lastname: Ochs
authors.forename: K
authors.initials: K
authors.lastname: Haag
authors.forename: M
authors.initials: M
authors.lastname: Kist
authors.forename: H E
authors.initials: HE
authors.lastname: Blum
mesh_terms: D000328:Adult; D000368:Aged; D000641:Ammonia / Q000097:blood*; D000907:Antibodies, Bacterial / Q000032:analysis; D005260:Female; D016481:Helicobacter Infections / Q000097:blood* / Q000150:complications; D016480:Helicobacter pylori / Q000276:immunology; D006501:Hepatic Encephalopathy / Q000097:blood* / Q000150:complications / Q000382:microbiology*; D006801:Humans; D015151:Immunoblotting; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012189:Retrospective Studies
chemical_list: D000907:Antibodies, Bacterial; D000641:Ammonia