Helicobacter pylori infection in hepatic encephalopathy: Relationship to plasma endotoxins and blood ammonia.
OBJECTIVE
Hepatic encephalopathy (HE) is frequently observed in patients with advanced liver disease and manifests a wide variety of neuropsychiatric signs and symptoms. Ammonia toxicity and bacterial endotoxins have been suggested as key determinants of HE onset whereas a role for Helicobacter pylori infection has not been established. We investigated the correlation between H. pylori infection and HE severity (evaluated through functional tests) in 60 outpatients with established liver cirrhosis and 20 non-cirrhotic controls.


METHODS
Fasting arterial blood ammonia, plasma endotoxins, and H. pylori infection status were investigated in all subjects.


RESULTS
H. pylori infection was documented in 35/60 (58%) patients and in 6/20 (30%) controls (P = 0.039). Significant differences were observed between patients with and withoutHE for age, presence of ascites, fasting arterial blood ammonia, plasma endotoxin, and H. pylori infection. Further, a significant increase in fasting arterial blood ammonia and plasma endotoxin was associated with H. pylori infection in cirrhotic patients. Last, medical treatment of H. pylori infection led to a significant decrease in HE severity and fasting arterial blood ammonia levels.


CONCLUSIONS
In conclusion, we submit that H. pylori infection might, in fact, play a role in increasing the circulating levels of ammonia and endotoxins in cirrhotic patients, thus facilitating the onset of HE.
Abdel-Hady
Hassan
H
Department of Internal Medicine, Faculty of Medicine, Minufiya University, Minufiya, Egypt.
Zaki
Ali
A
Badra
Gamal
G
Lotfy
Mahmoud
M
Selmi
Carlo
C
Giorgini
Alessia
A
El-Sayed
Mohamed
M
Badr
Reda
R