Helicobacter pylori: HE and SHE!

Abstract

Purpose: Purpose of the present study was to see the prevalence of subclinical hepatic encephalopathy (SHE) in patients of cirrhosis, to establish the correlation between presence of Helicobacter pylori (Hp) and hyperammonemia in these cases and to study the effects of anti-Helicobacter pylori treatment in patients of subclinical hepatic encephalopathy. Methods: Patients with end stage liver disease (based on clinical, ultrasonographic and endoscopic findings) without overt hepatic encephalopathy (HE), active upper gastrointestinal bleeding, associated neurological illness or with history of helicobacter eradication therapy within preceeding 3 months underwent blood ammonia measurement, rapid urease test and psychometric tests (Number connection, line tracing, figure connection tests). On the basis of the results of the psychometric tests, patients were divided into groups with and without subclinical hepatic encephalopathy (SHE). All patients with SHE were administered 1 week of triple Hp eradication therapy (Clarithromycin 250 mg bid +Lansoprazole 30 mg bid+Tinidazole 500 mg bid). Helicobacter status, blood ammonia level and psychometric tests were repeated after 4 weeks of completion of anti Hp therapy. Results: Out of 65 patients, 35 (53.08%) were found to be in the SHE group. Incidence of Hp in SHE group was 62.86% as compared to non SHE (36.70%). Blood ammonia levels in patients with SHE were significantly higher as compared to the non SHE group (p<0.001). There was a statistically significant drop in blood ammonia levels in Hp+patients after treatment (p<0.01). Out of 35 patients of SHE, 15 (42.86%) became non SHE (p<0.05) and out of 22 Hp+patients of SHE, 19 (86.36%) became Hp negative after treatment. Conclusion:Helicobacter pylori infection appears to play an important role in the development of SHE and eradication of this organism may be relevant in delaying the development of SHE and HE.