Role of Helicobacter pylori infection in the pathogenesis of minimal hepatic encephalopathy and effect of its eradication

  title={Role of Helicobacter pylori infection in the pathogenesis of minimal hepatic encephalopathy and effect of its eradication},
  author={Avinash Agrawal and Alok Gupta and Mam Chandra and Sciddhartha Koowar},
  journal={Indian Journal of Gastroenterology},
Background and AimHelicobacter 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… 
Number connection test and serum ammonia level were significantly improved in GI patients and positive H. pylori after eradication therapy, indicated that H.pylori infection is associated with high blood ammonia levels by urease enzyme and can lead to causation of HE.
Role of Helicobacter Pylori Infection in the Pathogenesis of Minimal Hepatic Encephalopathy and Effect of its Eradication
H. pylori infection is common among cirrhotic Egyptian patients and its role in the pathogenesis of MHE and ammonia production was proved and Screening of cirrhosis patients for detection and eradication of H.pylori is beneficial in the improvement and cure of M HE for better quality of life.
Helicobacter pylori, hyperammonemia, and hepatic encephalopathy: the effect of its eradication on minimal hepatic encephalopathy
Eradication of H. pylori infection ameliorates the manifestations of MHE and improves the results of both NCT and serum ammonia levels, however, further studies on the association between H.pylori infections and the pathogenesis of HE are strongly recommended.
Prevalence of Helicobacter pylori Infection in Patients with Minimal Hepatic Encephalopathy.
The amount of ammonia produced by H. pylori does not affect venous ammonia levels, and an additional benefit of H.pylori eradication in the treatment of hepatic encephalopathy in patients with LC is unlikely to occur.
The role of Helicobacter pylori in minimal hepatic encephalopathy
There is a highly significant association between H. pylori infection and MHE in cirrhotic patients and the treatment of H.pylori reduces the mean plasma ammonia levels and improves FCT results among the infected patients.
Minimal Hepatic Encephalopathy: Effect of H. pylori infection and small intestinal bacterial overgrowth treatment on clinical outcomes
Treatment of SIBO significantly improved the state of MHE in cirrhosis, however eradication of Hp infection did not improve MHE significantly, and patients with low Model for End-Stage Liver Disease (MELD) score and belonging to Child class B had significantly better improvement in MHE.
Helicobacter Pylori and the Incidence of Hepatic Encephalopathy
Cirrhotic patients (Child C) with positive H pylori were associated with higher incidence of HE, higher levels of ammonia and endotoxins than patients with negative H plyori.
Helicobacter pylori: Effect of coexisting diseases and update on treatment regimens.
Two novel eradication regimens, namely concomitant and hybrid therapy, have proven more effective in patients with dual- (clarithromycin- and metronidazole-) resistant H. pylori strains in geographic regions with high clarithromyzin resistance.
Does H. pylori Eradication Therapy Benefit Patients With Hepatic Encephalopathy?: Systematic Review
A systematic review of the role of H. pylori infection in the pathogenesis of (minimal) hepatic encephalopathy and the effect of eradication therapy on (M)HE found evidence from well-designed clinical studies is weak.


Effects of Helicobacter pylori eradication therapy on hyperammonaemia in patients with liver cirrhosis.
The diffuse distribution of H-pylori in the stomach contributes partly to hyperammonaemia in patients with liver cirrhosis, and the eradication of H pylori is effective in Patients with hyperam monaemia with diffuse H plyori infection inThe stomach.
Helicobacter pylori infection does not correlate with plasma ammonia concentration and hepatic encephalopathy in patients with cirrhosis.
A positive immunoblot for H. pylori antibodies neither correlates with plasma ammonia concentration nor with the incidence of hepatic encephalopathy in patients with cirrhosis of the liver and portosystemic shunt.
Helicobacter pylori is a risk factor for hepatic encephalopathy in acute alcoholic hepatitis: the ammonia hypothesis revisited. The Veterans Administration Cooperative Study Group No. 275.
Patients with acute, moderate or severe alcoholic hepatitis have a high H. pylori infection rate (as determined by serology), and those infected are at higher risk for portosystemic encephalopathy.
Clinical efficacy of lactulose in cirrhotic patients with and without subclinical hepatic encephalopathy
Lactulose treatment in cirrhotic patients with SHE is effective with respect to psychometric tests, and the results of the quantitative psychometric evaluation were significantly improved at 4 and 8 weeks after the beginning of the lactulose administration.
Current Theories on the Pathogenesis of Hepatic Encephalopathy
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  • Medicine, Psychology
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There is evidence to suggest that a subgroup of patients with HE have increased blood and CSF concentrations of substances that bind to GABA-related benzodiazepine receptors in brain, and further elucidation of neurotransmitter alterations in HE could result in novel “downstream” neuropharmacologic approaches to its prevention and treatment.
Complications of cirrhosis III. Hepatic encephalopathy.
Hepatic encephalopathy.
Collagen‐acetaldehyde adducts in alcoholic and nonalcoholic liver diseases
The association of this collagen‐acetaldehyde adduct with parameters of liver disease activity suggests that the adduct reflects the liver injury and may even contribute to its development, both in alcoholic and in nonalcoholic subjects.