Association of proton pump inhibitors with the risk of hepatic encephalopathy during hospitalization for liver cirrhosis

Abstract

Background: Hepatic encephalopathy is associated with altered gut microbiota. Proton pump inhibitors increase the risk of small bowel bacterial overgrowth.Objectives: This was a case-control study aimed at exploring the relationship of proton pump inhibitor use with the risk of hepatic encephalopathy during hospitalization in liver cirrhosis. Methods: Case and control groups were defined as cirrhotic patients who developed hepatic encephalopathy during hospitalization and those without hepatic encephalopathy at admission or during hospitalization, respectively. Age, gender, and Child-Pugh score were matched between the groups. Odds ratios with 95% confidence intervals were calculated to express the association of proton pump inhibitors with the risk of hepatic encephalopathy. Four subgroup analyses were performed after excluding patients with acute upper gastrointestinal bleeding, infections, and in-hospital death, and after matching model for end-stage liver disease score. Results: In the overall analysis, 128 patients were included in each group of cases and controls. The proportion of proton pump inhibitor use was significantly higher in the case group than the control group (79.7% vs 43%, p < 0.001). Proton pump inhibitor use (odds ratio ¼ 3.481, 95% confidence interval: 1.651-7.340, p ¼ 0.001) was independently associated with the development of hepatic encephalopathy in the multivariate analysis. In the four subgroup analyses, proton pump inhibitor use remained independently associated with the risk of hepatic encephalopathy. Conclusion: Proton pump inhibitor use might increase the risk of hepatic encephalopathy during hospitalization.

Characteristics of peptic ulcer bleeding in cirrhotic patients with esophageal and gastric varices

“…Proper attention has not been paid to the prevention and treatment of cirrhotic patients with peptic ulcer in current practice. One reason was that the application of proton pump inhibitors (PPI) in liver cirrhosis was still on doubt 23 – 26 , and the other reason was that the antibiotics for eradicating H. pylori may aggravate liver injury, especially for decompensated liver cirrhosis patients. Some studies proved that PPI did not increase the incidence of SBP 27 , while other studies verified that PPI can induce SBP 28 .…”

Characteristics of peptic ulcer bleeding in cirrhosis with esophageal and gastric varices

“…Proper attention has not been paid to the prevention and treatment of cirrhotic patients with peptic ulcer in current practice. One reason was that the application of proton pump inhibitors (PPI) in liver cirrhosis was still on doubt [23][24][25][26], and the other reason was that the antibiotics for eradicating H. pylori may aggravate liver injury, especially for decompensated liver cirrhosis patients. Some studies proved that PPI did not increase the incidence of SBP [27], while other studies verified that PPI can induce SBP [28].…”

Hepatic Encephalopathy and Nutrition Influences: A Narrative Review

“…Because of their inhibitory effect on gastric acid secretion, PPIs promote intestinal bacterial overgrowth and increased risk of bacterial translocation in cirrhotic patients . Thus, these agents are independently associated with increased risk of HE development . In a case‐control study in Taiwan, it was shown that PPI use increases the risk of HE development in a dose‐dependent fashion .…”