Helicobacter pylori: the effect of its eradication on minimal hepatic encephalopathy, hyperammonemia, and hepatic encephalopathy: the effect of its eradication on minimal hepatic encephalopathy

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Hepatic encephalopathy (HE) is a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction. Although the pathogenesis is unclear, ammonia is one of the key factors involved. Recently, it has been suggested that Helicobacter pylori contributes toward hyperammonemia in liver cirrhosis and its eradication may decrease blood ammonia concentration. The aim of this work was to assess the prevalence of H. pylori infection among patients with either minimal hepatic encephalopathy (MHE) or overt hepatic encephalopathy (OHE), and to determine the effect of its eradication among MHE patients.

Materials and methods

One hundred and twenty patients with HE were enrolled in the study; 60 of these patients had MHE, diagnosed by the number connection test (NCT), and 60 patients had OHE. H. pylori stool antigen was tested for all patients. MHE patients received triple anti-H. pylori treatment for 1 week. Four weeks after eradication therapy, H. pylori stool antigen serum ammonia levels were assessed, and the NCT was carried out.


H. pylori infection was more common in the MHE group of patients (61.7%) than in those with OHE (55%). Four weeks after triple therapy, H. pylori infection was successfully eradicated in 29 (78.4%) MHE patients; 86% of these patients showed an improved NCT. Serum ammonia level was significantly higher among MHE patients with noneradicated H. pylori infection.


Eradication of H. pylori infection ameliorates the manifestations of MHE and improves the results of both NCT and serum ammonia levels. However, further studies on the association between H. pylori infection and the pathogenesis of HE are strongly recommended.

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