Helicobacter pylori infection in cirrhotic patients with and without hepatic encephalopathy, correlation with ammonia level in blood

To determine the association between Helicobacter pylori infection, hepatic encephalopathy and blood ammonia level; 23 patients with liver cirrhosis and hepatic encephalopathy [HE] as well as 25 age and sex matched cirrhotics without encephalopathy were subjected to this study. They were c and idates for history taking, clinical examination and blood ammonia study. Endoscopy with urease test for biopsies from the gastric antrum was performed. Significantly more positive results for H. Pylori infection were obtained from cirrhotic subjects with HE than from cirrhotics without HE. H. Pylori positive patients with HE had a higher blood ammonia level than H. Pylori negative patients. Cirrhotics with H. pylori infection had a higher blood ammonia level than those negative for H. pylori. There was no significant difference between the prevalence of H. pylori in cirrhotics with and without endoscopic evidence of portal hypertensive gastropathy

Effect of parenteral vitamin K on prothrombin time and concentration in patients with established hepatocellular failure

This study was performed on 30 patients with established chronic liver cell failure without any clinical, laboratory or ultrasonographic evidence of obstructive jaundice and 10 healthy controls. Our patients showed significant prolongation of prothrombin time and the activated partial thromboplastin time before administering vitamin K denoting defects in both the extrinsic and intrinsic pathways of blood coagulation. Twenty patients were given 10 mg of vitamin K intramuscularly daily for 3 days followed by administration of the same dose intravenously for other 3 days. Ten patients were given intravenous infusion of 50 mg of vitamin k for 5 days. Haemostatic investigation was done before and after drug administration. The tested doses of vitamin K achieved significant improvements in prothrombin time and concentration in both groups of patients. The degree of improvement after intravenous administration was not significantly better than after intramuscular administration. On the other hand the improvement in prothrombin concentration after intravenous infusion was much better than after administration of vitamin K either intramuscularly or intravenously. So, we suggest to administer vitamin K. parenterally to all patients with hepatocellular disease with prolonged prothrombin time and to administer it as continuous intravenous infusion for cases with major clinical hemorrhage or before doing manoeuvres like liver biopsy, sclerotherapy or ERCP

Abnormal cardiovascular reflexes in patients with gastro-esophageal reflux

This study was conducted on 20 patients with endoscopic evidence of free gastro-esophageal reflux without evidence of other organ, systemic or metabolic disease and 20 normal controls. All patients and control individuals were subjected to a battery of five standard cardiovascular autonomic reflex tests namely heart rate changes with deep breathing, valsalva manoeuvre and standing up and blood pressure response with standing up and sustained hand grip. We found that the predominant abnormalities in such patients were in the heart rate tests while blood pressure changes were insignificant denoting that an abnormality in the cardiac vagal pathway exists in such patients and vagal dysfunction may possibly be related to the pathogenesis of this motility disorder. On the other hand the insignificant changes of blood pressure in our patients suggest that the sympathetic nervous system plays insignificant role in gastroesophageal reflux