The effect Helicobacter pylori (Hp)
infection and small intestinal bacterial over growth (SIBO) in minimal
hepatic encephalopathy (MHE) is not well understood. The aim of the study was to determine the effect of eradication of Hp
infection and SIBO treatment on MHE in patients with
cirrhosis. Patients with
cirrhosis were enrolled and MHE was determined by psychometric tests and critical flicker frequency analysis. Hp
infection and SIBO were assessed by
urea breath and
Hydrogen breath tests respectively in patients with
cirrhosis and in healthy volunteers. Patients with Hp
infection and SIBO were given appropriate treatment. At six weeks follow-up, presence of Hp
infection, SIBO and MHE status was reassessed. Ninety patients with
cirrhosis and equal number of healthy controls were included. 55 (61.1%) patients in the cirrhotic group were diagnosed to have underlying MHE. Among cirrhotic group, Hp
infection was present in 28 with MHE (50.9%) vs. in 15 without MHE (42.8%) (p = 0.45). Similarly, SIBO was present in 17 (30.9%) vs. 11 (31.4%) (p = 0.95) in patients with and without MHE respectively. In comparison with healthy controls, patients with
cirrhosis were more frequently harboring Hp and SIBO (47.7% vs. 17.7% (p < 0.001) and 31.1% vs. 4.4% (p < 0.001) respectively. On follow-up, all patients showed evidence of eradication of Hp and SIBO
infection. Treatment of SIBO significantly improved the state of MHE in cirrhotics, however eradication of Hp
infection did not improve MHE significantly. Additionally, patients with low Model for
End-Stage Liver Disease (MELD) score and belonging to Child class B had significantly better improvement in MHE. A large number of patients with
cirrhosis had either active Hp
infection or SIBO with or without MHE, compared to healthy controls. Treatment of SIBO significantly improved MHE in patients with
cirrhosis, whereas eradication of Hp did not affect the outcome of MHE in these patients.