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