Analysis of risk factors for chronic hepatic encephalopathy: the role of Helicobacter pylori infection.
OBJECTIVE
Elevated blood ammonia is an important pathogenic factor of hepatic encephalopathy. Although colonic bacteria are considered the main source of ammonia, the stomach in subjects with urease-producing Helicobacter pylori (H. pylori) is an alternative site. The objective of this study was to determine whether H. pylori is associated with this complication.


METHODS
After assessing liver function and portal hypertension, 55 cirrhotics were evaluated for encephalopathy and H. pylori infection. Response to 2 weeks of amoxicillin (2 g/day) and omeprazole (40 mg/day) was then assessed in 17 (13 H. pylori-positive, four H. pylori-negative) encephalopathic subjects.


RESULTS
H. pylori infection was more common (67 % vs 33%, p = 0.004) among encephalopathic patients. Additional factors associated with encephalopathy included older age (60.1 +/- 1.5 vs 49.8 +/- 2.4 yr, p = 0.001), lower albumin (3.17 +/- 0.08 vs 3.69 +/- 0.12 g/dl, p = 0.001), higher total bilirubin (2.24 +/- 0.20 vs 1.53 +/- 0.23 mg/dl, p = 0.034), greater ascites score (0.8 +/- 0.1 vs 0.3 +/- 0.1, p = 0.01), greater diuretic score (1.1 +/- 0.1 vs 0.3 +/- 0.1, p = 0.002), and greater modified Child score (6.7 +/- 0.3 vs 5.1 +/- 0.3, p = 0.001). When adjusted for severity of cirrhosis and age, H. pylori continued to demonstrate a statistical association (p = 0.039). After anti-H. pylori therapy, symptomatology in infected encephalopathic patients appeared to improve, whereas noninfected subjects were unaffected.


CONCLUSIONS
In cirrhotic patients, H. pylori infection is associated with hepatic encephalopathy, especially in younger patients with decompensated liver disease.
Dasani
B M
BM
Section of Liver Diseases and Nutrition, Alcohol Research and Treatment Center, Bronx Veterans Affairs Medical Center, Mount Sinai School of Medicine, New York, USA.
Sigal
S H
SH
Lieber
C S
CS
D000641:Ammonia / Q000097:blood; D000658:Amoxicillin / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001201:Ascites / Q000150:complications; D002908:Chronic Disease; D004232:Diuretics / Q000008:administration & dosage; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy; D016480:Helicobacter pylori; D006501:Hepatic Encephalopathy / Q000097:blood / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D008103:Liver Cirrhosis / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D013272:Stomach Diseases / Q000150:complications / Q000188:drug therapy
D000897:Anti-Ulcer Agents; D004232:Diuretics; D010406:Penicillins; D000641:Ammonia; D000658:Amoxicillin; D009853:Omeprazole