HELICOBACTER PYLORI & HEPATIC ENCEPHALOPATHY;

DO THEY REPRESENT TWO SIDES OF THE SAME COIN?

Abstract

Introduction: Hepatic encephalopathy is a common and serious complication affecting patients with liver disease. Helicobacter
pylori bacterium is postulated to be involved in worsening of this condition via its potential to create ammonia within the gastrointestinal tract.
Objective: The objective of this study was to determine the frequency of H pylori infection in cirrhotic patients who were suffering from hepatic
encephalopathy. Design: Case series study. Setting: Medical Unit-IV of Liaquat University Hospital, Hyderabad. Period: January to July 2010.
Methodology: Methodology: Every confirmed case of cirrhosis of liver who presented with acute confusional state, and loss of consciousness
to the emergency department of hospital was considered for enrollment in the study. The presence of hepatic encephalopathy was confirmed
and its severity grading was done clinically. Subsequently H pylori serological tests were done on every patient and a cut off value of 200:1
antibody titer was considered as positive. Primary outcome variable was presence or absence of H pylori antibody titer. Results: A total of 115
patients were selected, 69 (60%) were males and 46 (40%) were females. The mean age of patients was 49.36 years with a SD of 7.8. Antibody
to H pylori was present in 83 (72.17%) patients, whereas it was absent in 32 (27.83%). Two out of ten patients (20%) who were in Grade I hepatic
encephalopathy showed a positive test for H pylori antibody. In Grade II hepatic encephalopathy 17 out of 19 patients (89.47%) were having
positive H pylori antibody, in grade III 29 out of 34 (85.29%) and grade IV 35 out of 52 patients (67.3%) were having the antibody to H pylori.
Conclusions: Further studies are warranted to evaluate the arguments for and against the role of H pylori in the pathogenesis of hepatic
encephalopathy.