Effect of Helicobacter Pylori Eradication on Hepatic Encephalopathy



Shavakhi A¹ ; Shariatifar B¹ ; Akhtar S¹ ; Khodadoostan M² Show Affiliations
Source: Journal of Isfahan Medical School Published:2008

Abstract

Background: Until now, Ammonia has been considered to have a major role in pathogenesis of hepatic encephalopathy. It is probable that helicobacter pylori (H. pylori) infection, due to urease activity of the bacteria or its effect on blood Zinc level, leads to hyperammonemia and aggravates hepatic encephalopathy. This study assessed the prevalence of Helicobacter pylori infection among patients with hepatic encephalopathy and cirrhotic patients without hepatic encephalopathy; as well as the effect of H. pylori eradication on hepatic encephalopathy. Methods: The prevalence of H. pylori was evaluated in 42 patients with hepatic encephalopathy (21 hepatitis B and 21 hepatitis C cases) and was compared with 100 cirrhotic age and sex matched patients (49 hepatitis B and 51 hepatitis C cases) without stigmata of encephalopathy; patients were referred to Al-Zahra and Noor hospitals between 2004 to 2007. Then 27 of encephalopathic patients with infection were treated for H. pylori eradication, and eradication was confirmed in 23 of them via UBT. Grade of encephalopathy, number connection test (NCT) and flapping tremor were compared before and after eradication treatment. Findings: Overall, 73.6% of encephalopathic cases were infected versus 76% of cirrhotics in control group (p=0.675). Grade of encephalopathy and NCT was reduced in comparison with pretreatment (p=0.023 and 0.038, respectively); but alternation in flapping tremor was not statistically significant (p=0.248). Conclusion: Although there was not any significant difference in prevalence of H. pylori infection in cirrhotic patients with and without encephalopathy, eradication of H. pylori may lead to improvement of hepatic encephalopathy. © 2008, Isfahan University of Medical Sciences(IUMS). All rights reserved.