Role of Helicobacter pylori infection and its eradication in patients withsubclinical hepatic encephalopathy

Aims Helicobacter pylori infection in cirrhotic patients has been associate d with episodes of hepatic encephalopathy (HE), although conclusive data ar e still lacking. This prospective study has evaluated the prevalence of H. pylori infection in 37 patients with advanced cirrhosis of the liver and su bclinical hepatic encephalopathy (SHE), diagnosed by changes in psychometri c tests and/or electrophysiological tests, as well as the repercussion of H . pylori eradication on ammonaemia and the evolution of this disorder. Results A positive result for H. pylori infection was obtained in 22/37 (59 %) patients. Initial fasting blood levels of ammonia were high in both grou ps. Infected and non-infected patients showed similar levels (62.05 mmol/l v. 62.5 mmol/l), which were lowered by the standard diet, although statisti cal significance was only reached in the infected patient group (53.05 26 m mol/l; P < 0.05). Infection was eradicated in 19 patients, but no reduction of blood levels of ammonia was observed after H. pylori eradication among infected patients (52.37 +/- 29 mmol/l). No change has been found in either group after the administration of diet o r antimicrobials with regard to psychometric and/or electrophysiological te sts. Conclusions H. pylori infection does not contribute significantly to high b lood levels of ammonia in patients with advanced cirrhosis and SHE. Likewis e, H. pylori eradication does not induce any improvement in the psychometri c and/or electrophysiological tests used to define SHE. (C) 2001 Lippincott Williams & Wilkins.