Study of the Prevelance of Helicobacter Pylori Infection in Patients with Hepatic Encephalopathy in Medical Intensive Care Unit of Zagazig University Hospitals

Background: Ammonia is the main culprit and responsible for the development of hepatic encephalopathy (HE) among cirrhotic patients and colonic bacteria are thought to be the main source of ammonia production. Stomach is one of the alternate site for ammonia production in Helicobacter pylori (H. pylori) infected patients. Aim of the work: (1) To find out the prevalence of helicobacter pylori infection in hepatic encephalopathy who admitted to medical ICU in Zagazig University Hospitals.(2) Study the correlation between the presence of helicobacter pylori and severity of hepatic encephalopathy. Patients and methods: This cross-sectional study was conducted in Internal Medicine department, in medical intensive care unit of Zagazig University Hospitals from May 2015 to November 2015. Patients: This study included 450 subjects; divided into three groups; Group 1: 300 patients of liver cirrhosis with hepatic encephalopathy; Group 2: 75 patients of liver cirrhosis without hepatic encephalopathy; Group 3: 75 healthy controls without any disease. Cirrhotic patients regardless of its etiology diagnosed by abdominal ultrasonography and laboratory investigations. Patients with cirrhosis and hepatic encephalopathy determined by clinical assessment, which included mental status (alertness, mood, worry, and orientation) and complaints of sleep pattern disturbance, i.e., day/ night reversal (insomnia, daytime naps), consciousness.We excluded patients with neuropsychiatric disorders, patients with history of use of psychotropic, antiepileptic drugs or drug abuse, patients with portosystemic shunt operation, patients who had history of gastrointestinal bleeding within the previous 4 weeks, patients who suffer from dehydration or electrolyte imbalance, patients who are their body temperature exceed 37.5 C, patients with other causes of encephalopathy (e.g. metabolic, central, toxic or due to infections), patients who received antibiotics with anti- H. pylori spectrum in the past two weeks and patients with history of H. Pylori eradication treatment within the previous three months. Methods:All the included patients subjected to full history taking, informed consent was obtained; clinical assessment for hepatic encephalopathy grading and recorded in the pre-designed sheet and laboratory investigations including; Complete blood picture, ESR,Liver function tests including prothrombin time, serum total protein serum albumin, ALT, AST, total and direct bilirubin by automated analyzer Advia 120 Semens,Blood urea, creatinine, blood glucose level and electrolytes,Viral profile (HbsAg and anti-HCV),Fasting venous blood ammonia level,Helicobacter pylori IgG antibodies using ELISA,Helicobacter pylori stool antigen (HpSA),Abdominal ultrasonography,Chest x-ray,Upper gastrointestinal Endoscopy if possible,Child Pugh classification was done on admission by using parameter of serum bilirubin, serum albumin, prothormbin concentration, hepatic encephalopathy and ascites. Results: In the current study Mean of age of the 3 groups in our study were (control group, 53.93; cirrhotic group, 53.27 and HE group, 57.22), and there is no statistically significant difference between different groups in age, also it shows the number and percentage of sex in different groups (control; 40 males with percentage of 53.3% and 35 females with percentage of 46.7%), also cirrhotic group showed 35 males with percentage of 46.7% and 40 females with 53.3% percentage. While HE group has 220 males with percentage of 73.3% and 80 females with percentage of 26.7%. Also, there is no statistical significant difference as regard sex between the studied groups. Mean of blood ammonia level in control group is 118.6, in cirrhotic group is 164.6 and in HE group is 283.51 and there is a statistically significant difference between cirrhotic group and HE groupas, also in this study by comparison between H. pylori Ab/Ag positive and negative cases in HE group and mean of blood ammonia level it is found that the mean of ammonia increased significantly among HE patients with H. pylori, antigens, antibiodies positive than negative cases, also by comparison between different grades of hepatic encephalopathy and the mean of blood ammonia level it is found that the LSD test shows that there is significant increase in blood ammonia level in grades II and III in comparison with grade I HE patients. Conclusion: The frequency of h.pylori Ag&Ab among control group is 46.7%, cirrhotic group Ag is 53.3&Ab is 40% in HE group Ag is 58.3%&Ab is 48.3, also ammonia increased significantly among HE patients with H. pylori; antigens, antibiodies positive than negative cases, also it shows that there is significant increase in blood ammonia level in grades II and III in comparison with grade I HE patients. So, the finding of H. pylori in HE patients may be either co-incidence or co-relation suggesting positive correlation between the presence of helicobacter pylori and severity of hepatic encephalopathy.