Analysis of risk factors for chronic hepatic encephalopathy: The role of Helicobacter pylori infection

Bharat M. Dasani, Samuel H. Sigal, Charles S. Lieber

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

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. Conclusion: In cirrhotic patients, H. pylori infection is associated with hepatic encephalopathy, especially in younger patients with decompensated liver disease.

Original languageEnglish (US)
Pages (from-to)726-731
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume93
Issue number5
DOIs
StatePublished - May 1998
Externally publishedYes

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Chronic Brain Damage
Hepatic Encephalopathy
Helicobacter Infections
Helicobacter pylori
Brain Diseases
Ammonia
Omeprazole
Urease
Amoxicillin
Portal Hypertension
Bilirubin
Diuretics
Ascites
Liver Diseases
Albumins
Stomach
Fibrosis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Analysis of risk factors for chronic hepatic encephalopathy : The role of Helicobacter pylori infection. / Dasani, Bharat M.; Sigal, Samuel H.; Lieber, Charles S.

In: American Journal of Gastroenterology, Vol. 93, No. 5, 05.1998, p. 726-731.

Research output: Contribution to journalArticle

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abstract = "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. Conclusion: In cirrhotic patients, H. pylori infection is associated with hepatic encephalopathy, especially in younger patients with decompensated liver disease.",
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