Role of Helicobacter pylori infection in hyperammonemia and subclinical hepatic encephalopathy in cirrhosis of liver.
BACKGROUND
Gastric Helicobacter pylori infection is believed to be associated with a higher risk of hepatic encephalopathy among patients with cirrhosis of liver. However, the role of this infection in causation of subclinical hepatic encephalopathy has not been studied in detail.


METHODS
Patients with cirrhosis of liver but no hepatic encephalopathy underwent venous blood ammonia measurement, psychometric tests (number connection tests [NCT] and figure connection tests [FCT]), and gastric biopsies for presence of H. pylori infection. The results of blood ammonia and psychometric tests in the H. pylori-positive and -negative study subjects were compared.


RESULTS
Of 58 patients with liver cirrhosis studied, 31 had evidence of gastric H. pylori infection. Venous blood ammonia levels were comparable in patients with (median 29 mmol/L; range 18-47) and without (34 [15-48] mmol/L; p=ns) H. pylori infection. The time taken to complete NCT trail A (median 37 s [range 25-69] versus 36.5 [26-62]), NCT trail B (64 s [48-91] versus 63.5 [42-88]), FCT trail A (59 s [31-115] versus 58 [38-590]) and FCT trail B (76 s [55-187] versus 82 [36-125]) were similar in those with and those without H. pylori infection. For each of the four tests, the proportion of subjects with abnormal test results was similar among H. pylori-positive and -negative subjects.


CONCLUSIONS
Presence of H. pylori infection among patients with cirrhosis of liver but no overt hepatic encephalopathy is not associated with increase in blood ammonia concentration or deterioration in psychomotor function.
Kini
D
D
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow.
Aggarwal
R
R
Saraswat
V A
VA
Naik
S R
SR
D000293:Adolescent; D000328:Adult; D001707:Biopsy, Needle; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000453:epidemiology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D022124:Hyperammonemia / Q000175:diagnosis* / Q000453:epidemiology; D015994:Incidence; D007194:India / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity