Helicobacter pylori Infection in Children with Portal Hypertension and its Correlation with Serum Ammonia

Abstract Background Helicobacter pylori (H. pylori) infection is the most common bacterial infection worldwide, but it is even more common in developing countries. Through its urease enzyme, H. pylori converts urea into ammonia. Therefore, theoretically, H. pylori infection can augment the increase in plasma levels of ammonia in patients with portal hypertension. Aim To assess the prevalence of H. pylori infection among pediatric patients with portal hypertension and to assess the relationship between H. pylori infection and plasma ammonia. Patients and Methods This study was conducted on patients following up at Hepatology unit, children’s Hospital, Ain Shams University during the period from January to August 2023. Patients who had documented portal hypertension regardless of its grade and the status of their liver function were included. Patients who had active bleeding, sepsis, or who received antibiotics or proton pump inhibitors in the four weeks before enrollment were excluded. All patients were subjected to clinical evaluation, routine laboratory investigations and plasma ammonia level. They all underwent upper GIT endoscopy for gastric biopsy, and biopsies were subjected to rapid urease test and histopathological assessment was done for H. pylori infection using the Housten updated Sydney scoring system. Results Biopsies revealed that H. pylori infection was evident in 87% of the studied patients. 4 patients had grade-3 H. pylori infection, 15 had grade-2, 16 had grade-1, and 5 had no H. pylori infection. Patients with grade-3 H. pylori infection have significantly higher plasma ammonia as compared to grade 1 and 2 (p 0.007). None of the patients reached the critical plasma ammonia level, level of dialysis, of 400 ug/dl. There was no significant relationship between the patients’ diagnoses, liver function tests (PT, PTT, INR, Albumin, ALT, AST), result of rapid urease test, and plasma ammonia levels. Conclusion H. pylori infection is common among hepatic patients and is associated with significantly higher plasma ammonia level with more severe grades of infection. Further longitudinal studies are warranted to evaluate the real risk of H. pylori infection among patients with portal hypertension.