title: Role of Helicobacter pylori infection in the pathogenesis of minimal hepatic encephalopathy and effect of its eradication.
abstract: OBJECTIVE
  Helicobacter pylori (H. pylori) bacteria convert urea to ammonia, which has been implicated in causation of hepatic encephalopathy in patients with liver cirrhosis. The role of H. pylori infection in causation of minimal hepatic encephalopathy (MHE) has not been well studied. We looked at the relationship of H. pylori infection with MHE and hyperammonemia in patients with liver cirrhosis and the effects of anti-H. pylori treatment in patients with MHE and H. pylori infection.
  
  
  METHODS
  Patients with liver cirrhosis underwent psychometric tests for detection of MHE, rapid urease test to look for evidence of H. pylori infection and measurement of fasting blood ammonia levels. Patients with MHE were treated with triple-drug anti-H. pylori treatment for one week. Rapid urease test, blood ammonia levels, and psychometric tests were repeated four weeks after treatment.
  
  
  RESULTS
  H. pylori infection was found more often in patients with MHE (63%) than in those without MHE (37%). Blood ammonia levels were significantly higher in patients with MHE than those without. After H. pylori treatment in patients with MHE, blood ammonia levels showed a significant decline and psychometric test results returned towards normal.
  
  
  CONCLUSIONS
  In patients with liver cirrhosis, there is a significant association between H. pylori infection and MHE. Anti-H. pylori therapy results in reduction in blood ammonia levels and improvement in MHE.
authors.affiliation: Department of Medicine, Chattarpati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India. icuexpert@gmail.com
authors.forename: Avinash
authors.initials: A
authors.lastname: Agrawal
authors.forename: Alok
authors.initials: A
authors.lastname: Gupta
authors.forename: Mam
authors.initials: M
authors.lastname: Chandra
authors.forename: Sciddhartha
authors.initials: S
authors.lastname: Koowar
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D000328:Adult; D000641:Ammonia / Q000097:blood; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D016480:Helicobacter pylori; D006501:Hepatic Encephalopathy / Q000209:etiology*; D006801:Humans; D064747:Lansoprazole; D008103:Liver Cirrhosis / Q000150:complications* / Q000382:microbiology; D008297:Male; D011594:Psychometrics; D014011:Tinidazole / Q000627:therapeutic use
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D014011:Tinidazole; D064747:Lansoprazole; D000641:Ammonia; D017291:Clarithromycin