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Aims: Helicobacter pylori infection in cirrhotic patients has been associated with episodes of hepatic encephalopathy (HE), although conclusive data are still lacking. This prospective study has evaluated the prevalence of H. pylori infection in 37 patients with advanced cirrhosis of the liver and subclinical hepatic encephalopathy (SHE), diagnosed by changes in psychometric tests and/or electrophysiological tests, as well as the repercussion of H. pylori eradication on ammonaemia and the evolution of this disorder., Results: A positive result for H. pylori infection was obtained in 22/37 (59%) patients. Initial fasting blood levels of ammonia were high in both groups. Infected and non-infected patients showed similar levels (62.05 mmol/l v. 62.5 mmol/l), which were lowered by the standard diet, although statistical significance was only reached in the infected patient group (53.05 +/- 26 mmol/l; P < 0.05). Infection was eradicated in 19 patients, but no reduction of blood levels of ammonia was observed after H. pylori eradication among infected patients (52.37 +/- 29 mmol/l). No change has been found in either group after the administration of diet or antimicrobials with regard to psychometric and/or electrophysiological tests., Conclusions: H. pylori infection does not contribute significantly to high blood levels of ammonia in patients with advanced cirrhosis and SHE. Likewise, H. pylori eradication does not induce any improvement in the psychometric and/or electrophysiological tests used to define SHE.

We describe a patient with rapidly progressive pneumonia and a high level of serum lactate dehydrogenase, in whom postmortem study revealed the presence of a diffuse, small and large-cell multicentric non-Hodgkin's lymphoma, together with an invasive pulmonary aspergillosis. Aspergillosis is rare as a presenting feature of a lymphoproliferative disease; only one previous case has been reported to the best of our knowledge. Invasive aspergillosis and lymphoma should be considered in patients presenting with pneumonia and high level of lactate dehydrogenase.

We review standard management for patients with gallstones and common duct stones in the light of endoscopic sphincterotomy. As the sole treatment that procedure needs to be compared to surgical approaches, but now that laparoscopic cholecystectomy is available, there is some uncertainty about which surgical option should stand in comparison. We review salient points in the literature to urge further long term prospective comparisons of endoscopic sphincterotomy and surgical approaches.

Of the 18 endoscopic sphincterotomies performed on 18 cirrhotic patients for choledocholithiasis, a mortality rate of 16.6% was registered. However, this figure can be limited to 6.6% if we take only successful sphincterotomies (15/18, 83.3%) into account. After closely reviewing relevant literature, it would appear that operative mortality in comparable cases is much higher. We therefore recommend that endoscopic sphincterotomy, despite higher mortality rates when compared to the general population, should be the initial choice of management of choledocholithiasis in cirrhotic patients.