HELICOBACTER PYLORI AS A RISK FACTOR FOR CHRONIC HEPATIC ENCEPHALOPATHY
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Fifty patients with chronic hepatic encephalopathy (HE) were divided according to endoscopic and histopathological findings into Helicobacter pylori (H.pylori) positive (Group-A No. 30) and H.pylori negative (Group-B No. 20). Ten cirrhotic patients without HE nor H.pylori were chosen as cirrhotic control group, (Group-C). Groups-A and B were treated for HE. Group-A was also treated with anti- H.pylori triple therapy regimen. Both intragastric and plasma levels of ammonia were assessed before and after treatment. Eradication of H.pylori in 80 % of group-A patients correlated positively with the decreased both ammonia levels and with clinical improvement. Also, ammonia levels were found to be correlated well with the grade of liver disease according to Child's Classification. Group-B had undetectable gastric juice ammonia level with in significant decrease of ammonia plasma level after HE treatment (p>0.05). From these results it was concluded that H.pylori has a strong association with ammonia levels in patients with chronic HE, so strategy of HE management should include H.pylori diagnosis and eradication to improve the net result of therapy of C, HE management.