Helicobacter pylori and hepatic encephalopathy; do they represent two sides of the same coin?

ABSTRACT

Hepatic encephalopathy is a common and serious complication affecting patients with liver disease. Helicobacter pylori bacterium is postulated to be involved in worsening of this condition via its potential to create ammonia within the gastrointestinal tract. The objective of this study was to determine the frequency of H pylori infection in cirrhotic patients who were suffering from hepatic encephalopathy. Case series study. Medical Unit-IV of Liaquat University Hospital, Hyderabad. Period January to July 2010. Every confirmed case of cirrhosis of liver who presented with acute confusional state, and loss of consciousness to the emergency department of hospital was considered for enrollment in the study. The presence of hepatic encephalopathy was confirmed and its severity grading was done clinically. Subsequently H pylori serological tests were done on every patient and a cut off value of 2001 antibody titer was considered as positive. Primary outcome variable was presence or absence of H pylori antibody titer. A total of 115 patients were selected, 69 [60%] were males and 46 [40%] were females. The mean age of patients was 49.36 years with a SD of 7.8. Antibody to H pylori was present in 83 [72.17%] patients, whereas it was absent in 32 [27.83%]. Two out of ten patients [20%] who were in Grade I hepatic encephalopathy showed a positive test for H pylori antibody. In Grade II hepatic encephalopathy 17 out of 19 patients [89.47%] were having positive H pylori antibody, in grade III 29 out of 34 [85.29%] and grade IV 35 out of 52 patients [67.3%] were having the antibody to H pylori. Further studies are warranted to evaluate the arguments for and against the role of H pylori in the pathogenesis of hepatic encephalopathy