Eradication of H.pylori in patients with subclinical hepatic encephalopathy

Abstract EN

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 60 patients with advanced cirrhosis of the liver and subclinical hepatic encephalopathy (SHE), diagnosed by changes in psychometric test (number connection test,) 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 32/60 patients.

The diagnosis of H.pylori infection was made by endoscopic biopsy from the antral mucosa.

Initial fasting blood levels of ammonia were high in both groups.

Infected and non-infected patients showed similar levels (112.03 pmol/l vs 101.15 pmol/l) Standard treatment for H.pylori infection was given for both H.pylori +ve and -ve groups.

Blood ammonia levels were significantly reduced in both groups (80.37 pmol/l for H.pylori +ve group and 65.28 jumol/l for H.pylori -ve group).

Improvement of number connection test was significantly noticed in both group.

Conclusions H.pylori infection does not contribute significantly to high blood levels of ammonia in patiens with advanced cirrhosis and SHE.

The improvement in both blood ammonia levels and NCT after H.pylori treatment, seems to be due to the effect of antimicrobial drugs, as improvement had occurred in both H.pylori positive and negative groups.