Clinical investigation of the relationship between hepatic cirrhosis and helicobacter pylori infection
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Background: In cirrhotic patients, infection of the stomach with Helicobacter pylori (H. pylori) may produce more ammonia and, possibly increases the prevalence of hepatic encephalopathy. The role of H. pylori infection as a cause of hyperammonemia in cirrhosis is still debatable. Aims: To investigate the relationship between H. pylori infection, plasma ammonia level, and minimal hepatic encephalopathy (MHE) in cirrhotic patients. Methods: Patients with confirmed liver cirrhosis and healthy volunteers were selected. In all subjects, H. pylori assessment by rapid urease test (RUT) and histological examination for H. pylori were performed. If both the RUT and histological examination for H. pylori were positive, it would be regarded as H. pylori infection. The plasma ammonia level was detected, psychometric tests (number connection test A, NCT-A and digit symbol test, DST) and electroencephalogram (EEG) were performed. The patient could be diagnosed as having MHE whichever of the three tests was abnormal. The patients with H. pylori infection selected at random received one-week standard triple therapy (omeprazole, amoxycillin and clarithromycin), and bacterial eradication was assessed with 13C-urea breath test 6-8 weeks later. 7-9 weeks after the first examination, plasma ammonia level, psychometric assessments and EEG were repeated in all subjects. Results: One hundred and six cirrhotic patients and 30 healthy volunteers were enrolled in this study. The rate of H. pylori infection in cirrhotic patients (46.2%, 49/106) was higher than that in the healthy controls (30.0%, 9/30), but there was no significant difference between the two groups (P>0.05). The plasma ammonia level after eradication was not significantly different from that prior to the eradication in each group (P>0.05). No improvement in psychometric testing scores and EEG findings were observed in cirrhotic patients accompanied by MHE after eradication. Conclusions: This study failed to find any relationship between H. pylori infection, plasma ammonia level, and MHE in cirrhotic patients.
