Effect of triple therapy for helicobacter pylori eradication on hepatic encephalopathy: a randomized controlled trial

ABSTRACT

Helicobacter pylori [H. pylori] infection could potentially contribute to the development and severity of hepatic encephalopathy due to strong urease activity in the stomach of H. pylori infected cirrhotic patients. To assess the effect of triple eradication therapy for H. pylori on hepatic encephalopathy. Open randomized controlled clinical trial with 4 arms. liver diseases unit in Suez Canal University Hospital - tertiary care. Forty four Hp+ [Group 1] and 44 Hp- patients [Group 2] [based on rapid urease test of gastric biopsy] with hepatic encephalopathy grade 1 - 3. Triple eradication therapy for H. pylori versus standard treatment for hepatic encephalopathy in group 1 and antimicrobial therapy [without Omeprazole] versus standard treatment in group 2 for 14 days. Blind assessment of the grade of encephalopathy before and within three days from end of treatment. One grade improvement was considered treatment success. Success rate was 18.2% in standard treatment and 63.6% in triple therapy [p< 0.001] in H pylori positive. While in H. pylori negative patients the success was 9.1% in standard treatment versus 59.1% [P< 0.001] in and antimicrobial therapy. Success rate was not significantly different between standard treatment or between triple therapy and antimicrobial therapy among both groups. Among other factors in logistic regression models both triple therapy [OR 1.03<6.22<37.69, P= 0.047] and antimicrobial therapy [OR 2.09<11.42<59.46, P= 0.02] were significant predictors of success in the respective groups. Both triple eradication therapy for H. pylori and antimicrobial therapy only, equally improve the outcome of management of hepatic encephalopathy. The improvement may be attributed to the effect of antimicrobial therapy on ammonia producing gut flora rather than H. pylori eradication. H pylori eradication therapy adds no benefit in hepatic encephalopathy