title: Helicobacter pylori is a risk factor for hepatic encephalopathy in acute alcoholic hepatitis: the ammonia hypothesis revisited. The Veterans Administration Cooperative Study Group No. 275.
abstract: OBJECTIVE
  To determine whether infection with Helicobacter pylori is a risk factor for portosystemic encephalopathy in patients with acute, moderate or severe alcoholic hepatitis.
  
  
  METHODS
  Prospective, multicenter cohort study.
  
  
  METHODS
  Eight Veterans Affairs Hospitals.
  
  
  METHODS
  A cohort of 273 male patients enrolled in a Department of Veterans Affairs Cooperative Study performed to evaluate the efficacy of oxandrolone in combination with nutritional supplementation in moderate or severe alcoholic hepatitis.
  
  
  METHODS
  Admission serum IgG antibody titers against H. pylori by a specific and sensitive ELISA, demographic characteristics of patients, degree of protein calorie malnutrition, presence of ascites, bilirubin level, and known risk factors for hepatic encephalopathy (gastrointestinal bleeding, azotemia, hepatorenal syndrome, infection, and severity of disease); outcome was the presence of portosystemic encephalopathy.
  
  
  RESULTS
  Of 188 patients with decompensated alcoholic hepatitis available for analysis, 117 (62.2%) had encephalopathy. Ninety-two (78.6%) of these were infected with H. pylori, compared with 62% of patients without encephalopathy (p = 0.013). In a step-wise regression model, H. pylori was an independent risk factor (relative risk: 2.4, 95% CI: 1.2-4.8) adjusting for ascites and protein-calorie malnutrition.
  
  
  CONCLUSIONS
  Patients with acute, moderate or severe alcoholic hepatitis have a high H. pylori infection rate (as determined by serology), and those infected are at higher risk for portosystemic encephalopathy.
authors.affiliation: Department of Medicine, University of Kentucky, Lexington.
authors.forename: G P
authors.initials: GP
authors.lastname: Gubbins
authors.forename: T E
authors.initials: TE
authors.lastname: Moritz
authors.forename: L S
authors.initials: LS
authors.lastname: Marsano
authors.forename: R
authors.initials: R
authors.lastname: Talwalkar
authors.forename: C J
authors.initials: CJ
authors.lastname: McClain
authors.forename: C L
authors.initials: CL
authors.lastname: Mendenhall
mesh_terms: D000641:Ammonia / Q000378:metabolism*; D015331:Cohort Studies; D016481:Helicobacter Infections / Q000453:epidemiology*; D016480:Helicobacter pylori / Q000302:isolation & purification* / Q000378:metabolism; D006501:Hepatic Encephalopathy / Q000453:epidemiology* / Q000382:microbiology; D006519:Hepatitis, Alcoholic / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010074:Oxandrolone / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000641:Ammonia; D010074:Oxandrolone