Skip to main content
  • Original article
  • Open access
  • Published:

The role of Helicobacter pylori in minimal hepatic encephalopathy

Abstract

Background

One of the causes of death in patients with liver cirrhosis is hepatic encephalopathy (HE). Hyperammonemia is the most important cause of HE.

Aim

The aim of this work was to determine the relation between the Helicobacter pylori infection and minimal hepatic encephalopathy (MHE) in cirrhotic patients and to assess the outcome after treatment of H. pylori.

Patients and methods

This study was carried out on 50 Egyptian cirrhotic patients. The patients were divided into two groups: group A1 (32 positive H. pylori) and group A2 (18 negative H. pylori). Both groups were compared with 20 (age and sex matched) healthy individuals (group B). Patients and controls were subjected to an assessment of history, clinical examination, upper gastrointestinal endoscopy with gastric biopsy for histopathological examination of H. pylori, abdominal ultrasound, neuropsychiatric assessment using the figure connection test (FCT), complete blood count, liver and kidney function tests, and determination of plasma ammonia level. Plasma ammonia level and FCT were measured before and after treatment of H. pylori among patients with positive H. pylori.

Results

Plasma ammonia levels and FCT were highly significantly increased in all cirrhotic patients (group A) compared with the controls (group B) (P < 0.01) and in the positive H. pylori patients (group A1) compared with the negative H. pylori patients (group A2) (P < 0.01) and in group A1 before treatment compared with after treatment (P < 0.01).

Conclusions

There is a highly significant association between H. pylori infection and MHE in cirrhotic patients. The treatment of H. pylori infection reduces the mean plasma ammonia levels and improves FCT results among the infected patients. Therefore, H. pylori infection is an effective treatable risk factor for the clinical management of MHE.

References

  1. Tianzuo Z, Wolfgang S. The diagnosis and treatment of minimal hepatic encephalopathy. Dtsch Arztebl Int 2012; 109:180–187.

    Google Scholar 

  2. Prakash R, Mullen KD. Mechanisms, diagnosis and management of hepatic encephalopathy. Nat Rev Gastroenterol Hepatol 2010; 7: 515–525.

    Article  Google Scholar 

  3. Duarte-Rojo A, Estradas J, Hernández-Ramos R, Ponce-de-León S, Córdoba J, Torre A. Validation of the psychometric hepatic encephalopathy score (PHES) for identifying patients with minimal hepatic encephalopathy. Dig Dis Sci 2011; 56:3014–3023.

    Article  Google Scholar 

  4. Agrawal A, Gupta A, Chandra M, Koowar S. Role of Helicobacter pylori infection in the pathogenesis of minimal hepatic encephalopathy and effect of its eradication. Indian J Gastroenterol 2011; 30:29–32.

    Article  Google Scholar 

  5. Perazzo JC, Tallis S, Delfante A, Souto PA, Lemberg A, Eizayaga FX, Romay S. Hepatic encephalopathy: an approach to its multiple pathophysiological features. World J Hepatol 2012; 4:50–65.

    Article  Google Scholar 

  6. Montgomery JY, Bajaj JS. Advances in the evaluation and management of minimal hepatic encephalopathy. Curr Gastroenterol Rep 2011; 13:26–33.

    Article  Google Scholar 

  7. Muzaffar A, Muhammad R, Akbar Y, Zafrullah, Roohi B, Bhuvnesh Kumar M. Frequency of Helicobacter Pylori among hepatic encephalopathic patients in liver cirrhosis. JLUMHS 2012; 11:93–96.

    Google Scholar 

  8. De Francesco V, Ierardi E, Hassan C, Zullo A. Helicobacter pylori therapy: present and future. World J Gastrointest Pharmacol Ther 2012; 3:68–73.

    Article  Google Scholar 

  9. Morgan M, Stubbs M. Hepatic encephalopathy in patients with cirrhosis. Int J Clin Rev 2011; 02:04.

    Google Scholar 

  10. Weissenborn K. PHES: one label, different goods?. J Hepatol 2008; 49:308–312.

    Article  Google Scholar 

  11. Agrawal A, Gupta A, Chandra M, Koowar S. Role of Helicobacter pylori infection in the pathogenesis of minimal hepatic encephalopathy and effect of its eradication. Indian J Gastroenterol 2011; 30:29–32.

    Article  Google Scholar 

  12. Si J, Cao Q, Gao M, Fang L, Qian G, Wang Y. Changes in serum ammonia concentration in cirrhotic patients with Helicobacter pylori infection. Chin Med J (Engl) 2000; 113:1080–1081.

    CAS  Google Scholar 

  13. Jiang HX, Qin SY, Min ZG, Xie MZ, Lin T, Hu BL, Guo XY. Association of Helicobacter pylori with elevated blood ammonia levels in cirrhotic patients: a meta-analysis. Yonsei Med J 2013; 54:832–838.

    Article  Google Scholar 

  14. Chen S, Wang L, Zhu Q, Cai J, Chen T, Si J. Effect of H. pylori infection and its eradication on hyperammonemia and hepatic encephalopathy in cirrhotic patients. World J Gastroenterol 2008; 14:1914–1918.

    Article  Google Scholar 

  15. Huber M, Rossle M, Siegerstetter V, Ochs A, Haag K, Blum HE, et al. Helicobacter pylori infection does not correlate with plasma ammonia concentration and hepatic encephalopathy in patients with cirrhosis. Hepatogastroenterology 2001; 48:541–544.

    CAS  PubMed  Google Scholar 

  16. Scotiniotis I, Lucey M, Metz D. Helicobacter pylori infection is not associated with subclinical hepatic encephalopathy in stable cirrhotic patients. Dig Dis Sci 2001; 46:2744–2751.

    Article  CAS  Google Scholar 

  17. Shanid AS, Sojan GK, Srijaya S, Premaletha N, Kattoor RV. H-pylori infection in patients with liver cirrhosis: prevalence and association with PHG. Annals of Gastronterology 2013; 26:1–6.

    Google Scholar 

  18. Batmanabane V, Kate V, Ananthakrishnan N. Prevalence of Helicobacter pylori in patients with portal hypertensive gastropathy – a study from south India. Med Sci Monit 2004; 10:133–136.

    Google Scholar 

  19. Zullo A, Hassan C, Morini S. Hepatic encephalopathy and Helicobacter pylori: a critical reappraisal. J Clin Gastroenterol 2003; 37:164–168.

    Article  Google Scholar 

  20. Schulz C, Schütte K, Malfertheiner P. Does H. pylori eradication therapy benefit patients with hepatic encephalopathy?: systematic review. J Clin Gastroenterol 2014; 48:491–499.

    Article  CAS  Google Scholar 

  21. Kini D, Aggarwal R, Saraswat VA, Naik SR. Role of Helicobacter pylori infection in hyperammonemia and subclinical hepatic encephalopathy in cirrhosis of liver. Indian J Gastroenterol 2001; 20:237–240.

    CAS  PubMed  Google Scholar 

  22. Rekha C, Phanidhar S, Sagar AV, Revathi A, Asra WA. Role of Helicobacter pylori and hyperammonemia in subclinical hepatic encephalopathy in cirrhosis of liver. Indian J Clin Biochem 2007; 22:136–139.

    Article  CAS  Google Scholar 

  23. Miquel J, Barcena R, Boixeda D, Fernedanz J, SanRoman AL, Martomanz-Argila C, Ramosa F. Role of Helicobacter pylori infection and its eradication in patients with subclinical hepatic encephalopathy. Eur J Gastroenterol Hepatol 2001; 13:1067–1072.

    Article  CAS  Google Scholar 

  24. Shavakhi A, Shariatifar B, Chuloo S, Minakari M, Sami M. Effect of Helicobacter pylori eradication on hepatic encephalopathy. Hep Mon 2008; 8:121–124.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Seham S. El-seid.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

El-seid, S.S., Attia, F.A., El-Raouf, M.A. et al. The role of Helicobacter pylori in minimal hepatic encephalopathy. Egypt J Intern Med 27, 26–31 (2015). https://doi.org/10.4103/1110-7782.155849

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1110-7782.155849

Keywords