Effect of Helicobacter pylori eradication on serum ammonia levels in patients with chronic liver disease.

BACKGROUND: Helicobacter pylori infection has been implicated in the development of encephalopathy in chronic liver disease (CLD); this is possibly due to increased production of ammonia by the action of bacterial urease on urea in the gastric lumen. AIM: To evaluate whether H. pylori eradication in patients with CLD affects arterial ammonia levels. METHODS: Forty-six patients with CLD (40 alcoholic, 6 post hepatitis B; Child's class A 7, B 17, C 22) and 36 patients with symptoms of acid-peptic disease (APD) underwent gastrointestinal endoscopy and biopsy; gastric biopsies were evaluated for H. pylori status using rapid urease test and histology. H. pylori-positive subjects received quadruple-drug eradication therapy for 2 weeks. Fasting arterial plasma ammonia levels were estimated before and after eradication of H. pylori. RESULTS: H. pylori infection was present in 21 of 46 (45.7%) patients with CLD and 23 of 36 (63.9%) with APD. At baseline, mean (SD) ammonia levels were higher in the CLD group (97.4 [10.9] versus 81.3 [7.7] mcg/dL in the APD group; p = 0.0001), irrespective of H. pylori status. Amongst patients with liver disease, arterial ammonia levels were similar in the H. pylori-positive and -negative patients (94.1 [9.7] and 100.2 [11.3] mcg/dL, respectively); however, ammonia levels were higher in patients in Child's class C (102.7 [11.4] mcg/dL/dL) than in those in class A (88.4 [1.6] mcg/dL; p < 0.002) or B (94.1 [9.7] mcg/dL; p < 0.002). In patients with APD, ammonia levels were higher in H. pylori-positive patients (85.3 [6.4] versus 74.1 [3.3] mcg/dL; p < 0.001). After eradication of H. pylori infection, ammonia levels decreased to 88.4 (10.0) mcg/dL in CLD and 76.7 (4.8) mcg/dL in APD (p = 0.001 as compared to baseline). There was no difference in post-eradication ammonia levels between Child's classes. CONCLUSION: Levels of arterial blood ammonia are higher in CLD than in APD, and correlate with severity of liver disease. H. pylori eradication was associated with reduction in arterial ammonia levels in patients with CLD.

Scientific validation of the Chinese caterpillar medicinal mushroom, Ophiocordyceps sinensis (Ascomycetes) from India: immunomodulatory and antioxidant activity.

In the present study, we aimed to elucidate the antioxidant property and anti-inflammatory activity of the aqueous extract of the Indian species of Ophiocordyceps sinensis (AECS), which demonstrates medicinal activity against numerous diseases. The chemical composition of AECS was quantified using a colorimeteric technique to determine the total phenolic and flavonoid contents. Antioxidant activity was determined by assays for 2,2'-azinobis(3-ethylbenzothiazoline-6-sulphonic acid)diammonium salt (ABTS); 2,2-diphenyl-1-picryl-hydrazyl (DPPH); and ferric reducing antioxidant power (FRAP). Adenosine nucleoside and nitrogenous bases (adenine and uracil) were also quantified by high-performance thin layer chromatography (HPTLC). Furthermore, the aqueous extract was also analyzed for anti-inflammatory activity in vitro using THP1 cells. THP1 cells were treated with and without lipopolysaccharide (LPS) and AECS (at 25 µg/mL, 50 µg/mL and 100 µg/mL, respectively) for 24 h. After 24 h, supernatants were harvested and kept at -80°C until the cytokine assays were performed. Furthermore, nitric oxide (NO) content was also estimated in treated and untreated murine peritoneal macrophages using Griess reagent. AECS significantly suppressed LPS-induced release of TNF-α and IL-1ß in THP1 cells and significantly suppressed NO release in macrophage cells without exerting any toxic effect. These results indicate the anti-inflammatory activity of AECS. Additionally, this extract also has an antioxidant property, as high contents of phenols and flavonoids are present in the extract with considerable reducing power. The results of this study clearly demonstrate the potent antioxidant property and anti-inflammatory activity of AECS. Therefore, consumption of AECS may be clinically useful to protect against inflammatory diseases.