title: Association of Helicobacter pylori with elevated blood ammonia levels in cirrhotic patients: a meta-analysis.
abstract: OBJECTIVE
  The association between Helicobacter pylori (H. pylori) and blood ammonia levels in cirrhotic patients is controversial. We aimed to clarify this controvercy by performing a meta-analysis of published studies.
  
  
  METHODS
  We searched PubMed, EMBASE and Cochrane library for studies which explored the association between H. pylori and blood ammonia levels in cirrhotic patients before May 2012. Six cohort studies involved in 632 H. pylori positive and 396 H. pylori negative cirrhotic patients were eligible for our analysis. The summary estimates were presented as standard means differences (SMD) and 95% confidence intervals (CI) from individual studies.
  
  
  RESULTS
  Overall, there was significant association between H. pylori infection and the elevated blood ammonia levels in cirrhotic patients (SMD=0.34, 95% CI=0.21-0.47, I²=42.1%). Sensitivity analysis further confirmed this association. Subgroup analysis showed that the association was found only in Asian ethnicity, but not in Caucasian ethnicity.
  
  
  CONCLUSIONS
  H. pylori infection is associated with elevated blood ammonia levels in cirrhotic patients, and more large scale studies and stratify analysis are warranted in order to further evaluate this association.
authors.affiliation: Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, Shuang-Yong Road 6, Nanning 530021, Guangxi, PR China. luckydoc123@qq.com
authors.forename: Hai-Xing
authors.initials: HX
authors.lastname: Jiang
authors.forename: Shan-Yu
authors.initials: SY
authors.lastname: Qin
authors.forename: Zhi-gang
authors.initials: ZG
authors.lastname: Min
authors.forename: Ming-Zhi
authors.initials: MZ
authors.lastname: Xie
authors.forename: Tao
authors.initials: T
authors.lastname: Lin
authors.forename: Bang-Li
authors.initials: BL
authors.lastname: Hu
authors.forename: Xiao-Yun
authors.initials: XY
authors.lastname: Guo
mesh_terms: D000641:Ammonia / Q000097:blood; D044466:Asian People; D016481:Helicobacter Infections / Q000097:blood*; D016480:Helicobacter pylori / Q000472:pathogenicity; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000382:microbiology*; D017594:Publication Bias; D012044:Regression Analysis; D044465:White People
chemical_list: D000641:Ammonia
keywords: Helicobacter pylori; ammonia; blood; meta-analysis