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.