Association between proton pump inhibitors and hepatic encephalopathy

Bian, Jin; Wang, Anqiang; Lin, Jianzhen; Wu, Liangcai; Huang, Hanchun; Wang, Shanshan; Yang, Xiaobo; Lü, Xin; Xu, Yiyao; Zhao, Haitao

doi:10.1097/md.0000000000006723

Cited by 28 publications

(20 citation statements)

References 33 publications

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“…Current standard treatments for HE, such as lactulose or antibiotics, act through the manipulation of the gut flora. Bian et al [33] reviewed 3 case-control studies, and showed that hepatic insufficiency patients receiving PPIs had a significantly increased risk of developing HE (OR 1.76, 95% CI 1.15-2.69) compared with PPI nonusers. Recently, Tsai et al [34] conducted a nested case-control study analysis in a cohort from the Taiwan National Health Insurance Database.…”

Section: Infectious and Inflammatory Diseases Possibly Associated Witmentioning

confidence: 99%

Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use

Naito

Kashiwagi²,

Takagi³

et al. 2018

Digestion

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Background: Gut dysbiosis associated with the use of proton-pump inhibitors (PPIs) has been found to lead to the occurrence of infectious and inflammatory adverse events. A longitudinal observational cohort study has demonstrated the heightened risk of death associated with PPI use. Summary: We evaluated meta-analyses to determine the association between PPI use and infectious and inflammatory diseases. Meta-analyses showed that PPI use is a potential risk for the development of enteric infections caused by Clostridium difficile, as well as small intestinal bacterial overgrowth, spontaneous bacterial peritonitis, community-acquired pneumonia, hepatic encephalopathy, and adverse outcomes in inflammatory bowel disease. We also examined changes in the composition and function of the gut microbiota with the use of PPIs. PPI use significantly increased the presence of Streptococcaceae and Enterococcaceae, which are risk factors for C. difficile infection, and decreased that of Faecalibacterium, a commensal anti-inflammatory microorganism. Key Message: High-throughput, microbial 16S rRNA gene sequencing has allowed us to investigate the association between the gut microbiome and PPI use. Future prospective comparison studies are necessary to confirm this association, and to develop new strategies to prevent complications of PPI use

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Section: Infectious and Inflammatory Diseases Possibly Associated Witmentioning

confidence: 99%

Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use

Naito

Kashiwagi²,

Takagi³

et al. 2018

Digestion

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“…Proton pump inhibitors (PPIs), a major treatment for gastroesophageal reflux, have been shown to be related to HE 110 – 112 . While the exact mechanism underlying this association is not known, it is currently thought to be due to alterations in the gut microbiome.…”

Section: Recent Research On the Treatment Of Hepatic Encephalopathymentioning

confidence: 99%

“…While the exact mechanism underlying this association is not known, it is currently thought to be due to alterations in the gut microbiome. PPIs have a known association with gut dysbiosis 110 – 112 . A case-control study of one million people in Taiwan followed for an average of nearly 14 years demonstrated that in patients with both cirrhosis and HE, 38% used a PPI 112 ; all categories of PPIs, except rabeprazole, led to an increased risk of HE 112 .…”

Section: Recent Research On the Treatment Of Hepatic Encephalopathymentioning

confidence: 99%

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Recent advances in hepatic encephalopathy

2017

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Hepatic encephalopathy describes the array of neurological alterations that occur during acute liver failure or chronic liver injury. While key players in the pathogenesis of hepatic encephalopathy, such as increases in brain ammonia, alterations in neurosteroid levels, and neuroinflammation, have been identified, there is still a paucity in our knowledge of the precise pathogenic mechanism. This review gives a brief overview of our understanding of the pathogenesis of hepatic encephalopathy and then summarizes the significant recent advances made in clinical and basic research contributing to our understanding, diagnosis, and possible treatment of hepatic encephalopathy. A literature search using the PubMed database was conducted in May 2017 using “hepatic encephalopathy” as a keyword, and selected manuscripts were limited to those research articles published since May 2014. While the authors acknowledge that many significant advances have been made in the understanding of hepatic encephalopathy prior to May 2014, we have limited the scope of this review to the previous three years only.

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“…76,77 PPIs have been shown to be associated with development of HE. 78,79 Patients prescription list should be checked for PPI, and PPIs should be discontinued unless there is a clear indication for their use.…”

Section: Hepatic Encephalopathymentioning

confidence: 99%

Medical Management of Portal Hypertension and Its Complications

Singh

McCullough

2017

Dig Dis Interv

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Portal hypertension, most commonly caused by cirrhosis, is defined as an elevated hepatic venous pressure gradient that can lead to complications including ascites, hepatic, esophageal/gastric varices, hepatic encephalopathy, and hepatorenal syndrome. While these complications are initially managed by medical and endoscopic treatments, progressive decompensation of liver disease may lead to liver transplantation.

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Association between proton pump inhibitors and hepatic encephalopathy

Cited by 28 publications

References 33 publications

Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use

Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use

Recent advances in hepatic encephalopathy

Medical Management of Portal Hypertension and Its Complications

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