The Impact Of Helicobacter Pylori On Hyperammonemia And Hepatic Encephalopathy

Objective The aim was to evaluate the relationship among H.pylori infection, blood ammonia concentrations, and hepatic encephalopathy status by prospective and multiecenter clinical studying, and to investigate the effect of H.pylori eradication on blood ammonia levels.Methods From Jul 2003 to Jan 2005 , 457 with cirrhotic patients in 18 hospitals of 5 regions in Zhejiang Province were enrolled. The patients were divided into two groups according to H.pylori infection status. All patients were evaluated for the demographic checklists (gender, age, and the cause of cirrhosis) , number connection test, H.pylori infection, liver impairment level, blood ammonia concentrations and hepatic encephalopathy status. All patients with H.pylori infection were given one week of " triple combination therapy" with Omeprazole plus Clarithromycin and Tinidazole. ¹⁴C urea breath test were repeated and the mental symptoms and blood ammonia levels were reassessed one month later after the eradication therapy.Results (1) The overall H.pylori infection rate was 65.3% (230/352) in cirrhotic patients. The HE happened with 57.1% in cirrhotic inpatients. Subclinical hepatic encephalopathy (SHE) were detected in 31.4% of cirrhotic patients (47/151) . (2) The blood ammonia concentration in Hp (-) and Hp (+ ) cirrhotic patients was (85.5±55.8) umol/1 and (62.2±54.0) umol/1 respectively ( P<0.01) , the level of blood ammonia concentration after Hp eradication were significantly reduced ( P<0.01 ) . Moreover . HE were more frequently observed in patients with Hp infection than without it (66.5 % vs 33.9%, P<0.01). (3 ) It was detected the Hp prevalence had significant difference among cirrhotics without overt HE (50%), and those with HE ranged from stage one to three(70.8%.83.5%,80.0% respectly) (P<0.01) . The level of blood ammonia had significant difference among the cirrhotics without overt HE (56.0±44.5 umol/1) (P<0.01 ). and those with HE ranged from stage one to three (87.8±59.2 umol/1, 99.6±64.2u.mol/1 , 98.2±33.7umol/l,respectly (4) Logistic regression analysis showed that there was close relationship between HE prevalence and the blood ammonia concentration, Child-Pugh scale, upper gastrointestinal bleeding, electrolyte abnomality, and urea nitrogen, which were regarded as risk factors of HE.Conclusion H.pylori infection was an important pathgenetic factor of inducing with high blood ammonia concentration and hepatic encephalopathy in cirrhotic patients. H.pylori eradication was helpful tools in treatment and prevention of HE.