HELICOBACTER-PYLORI AND THE LIVER - ANY RELATIONSHIP

Helicobacter pylori infection is being correlated to a number of human diseases, among which also those of the liver: From a clinical point of view: 4 ''areas of interest'' for the suggested correlation can be identified: 1. Helicobacter pylori and portal hypertension-related con gestive gastropathy in cirrhotics. There are, in the literature, at le ast 7 studies confirming that the microorganism has no role in causing or worsening the disease. 2. Helicobacter pylori and duodenal nicer i n cirrhotic patients. Apparently, in the cirrhotic patient, the microo rganism has no role in causing duodenal nicer 3. Helicobacter pylori a mmonia production and hepatic encephalopathy In this case, there are a t least three studies showing that Helicobacter pylori infection incre ases the risk of developing encephalopathy irt the cirrhotic patient t his being a somewhat expected finding. 4. Helicobacter pylori infectio n in chronic liver disease and its diagnosis. Evidence in the literatu re suggests: a) that hypertensive gastropathy might not represent a fa vourable environment for Helicobacter pylori thus making the diagnosti c sensitivity of the biopsy lower than expected, and b) that even sero logical diagnosis might provide data of difficult interpretation, as s hown in non alcoholic cirrhosis and, by our own group, in primary bili ary cirrhosis. More intriguing are the data generated with respect to the potential capacity of Helicobacter pylori and Helicobacter pylori- like bacteria such as, in particular; Helicobacter hepaticus to damage the liver by producing toxins with a granulating effect on liver cell lines ,which, in vivo, through the portal tract, might reach the live r thus causing hepatocellular damage. The point has been addressed by a number of investigators and autoimmune mechanisms have also been sug gested In summary from the clinical point of view some evidence sugges ts that Helicobacter pylori infection might be relevant in the pathoge nesis of hepatic encephalopathy in cirrhosis. The data being generated with respect to a direct hepatotoxicity are, at present, stimulating but only speculative.