The Role of Helicobacter Pylori Eradication on the Pathogenesis of Minimal Hepatic Encephalopathy in Egyptian Patients with Liver Cirrhosis

Abstract

Background Hepatic Encephalopathy (HE) is defined as alteration of mental state in the absence of other causes of encephalopathy due to liver failure and/or abnormal shunting of blood from portal to systemic circulation often accompanied by elevated blood ammonia. Objectives The aim of this study was to determine the relation between the Helicobacter pylori infectionand minimal hepatic encephalopathy (MHE) in cirrhotic patients and to assess the outcome after treatment of H. pylori. Patients and Methods This study was can•ied out at Egyptian Railway Medical Centre at the in-patients section at Gastroenterology and Hepatology Medicine Department with chronic liver disease who agreed to participate in the study. After performing the psychometric tests the patients were allocated in one of the two groups according to test results: Group I: consisted of 30 consecutive patients who have chronic liver disease and presented with evidence of Minimal hepatic encephalopathy (MHE), as recognized by positive psychometric tests, Group Il: included 30 consecutive patients who presented with chronic liver disease and did not have Minimal hepatic encephalopathy, as confirmed by negative psychometric test. Results In this study a significant reduction was found in blood ammonia levels in MHE and non- MHE after triple-drug anti-H. pylori treatment (p < 0.001). This reduction was more marked in patients with MHE group compared to non-MHE group with % improvement in ammonia level 26.1 ± 8.36 umol/L and 17.79 ± 7.308 for MHE and non-MHE respectively. This finding indicates that H. pylori may contribute to the development of hyperammonemia in patients with liver disease and MHE. The role of H. pylori in the pathogenesis of hyperammonemia has been shown in previous studies which showed a reduction in blood ammonia levels after eradication of H.pylori infection. Conclusion Helicobacter Pylori infection was more prevalent in patients with MHE than without MHE. Serum arnrnonia levels were significantly higher in MHE patients than without MHE and even higher in H.pylori positive patients than without H.pylori infection. Helicobacter Pylori eradication treatment significantly improves ammonia levels, results of psychometric tests and improves manifestations of MHE.

Frequency of H. pylori in liver cirrhosis patients with overt Hepatic encephalopathy at tertiary care hospital, Karachi.

“…Recent studies are exploring the effects of H. pylori eradication on HE. Amer et al 24 , Razik et al, 25 and Elmataway et al 26 , in their study, concluded that H. pylori eradication therapy was associated with both; improvement of symptoms of MHE and reduction in the ammonia level 24 . Contrary to this, a local study revealed no improvement in symptoms of MHE after H. pylori eradication 22 .…”

Frequency of H.Pylori in Liver Cirrhosis Patients with Overt Hepatic Encephalopathy: A Cross-Sectional Study Design

“…Amer et al 25 , Razik et al 26 , and Elmataway el al. 27 in their studies identifies that removal therapy of H.Pylori infection is positively linked with the improvement in symptoms of Hepatic encephalopathy and reduce ammonia extent. On the other hand one of the study concluded no improvcement in HE symptoms after treatment of H.Pylori infection.…”