Helicobacter pylori infection does not correlate with plasma ammonia concentration and hepatic encephalopathy in patients with cirrhosis.
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.
Huber
M
M
Department of Gastroenterology and Hepatology, Albert Ludwigs University School of Medicine, D-79106 Freiburg, Germany.
Rössle
M
M
Siegerstetter
V
V
Ochs
A
A
Haag
K
K
Kist
M
M
Blum
H E
HE
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
D000907:Antibodies, Bacterial; D000641:Ammonia