PPIs are not associated with a lower incidence of portal-hypertension-related bleeding in cirrhosis

Abstract

Portal hypertension bleeding is not associated with PPI use. These findings do not support the prescription of PPIs in patients with chronic liver disease with no currently accepted indication.

The impact of proton pump inhibitor therapy on patients with liver disease

“…A systematic review published this year evaluated the evidence for the use of PPIs in the management of varices, finding that a short course of PPIs should only be used after endoscopic variceal ligation if healing was a concern. 14 PPIs do not contribute to the long-term prophylaxis of portal hypertension related bleeding, 15 nor do they have a role in the acute treatment of a gastroesophageal variceal haemorrhage. 14 There is convincing evidence that liver cirrhosis associated hypertensive gastropathy causes a reduction in gastric acid secretion.…”

Use of proton pump inhibitors in chronic liver diseases

“…Although benefits of PPI treatment have clearly been demonstrated in the management of peptic ulcer disease in patients with cirrhosis and in the immediate postendoscopic banding period to prevent rebleeding, evidence for the use of PPIs outside of these indications is lacking . Though PPIs are frequently prescribed in practice, PPI treatment has been shown to be ineffective in the primary prevention of upper gastrointestinal (GI) bleeding in patients with cirrhosis, including those related to varices and portal hypertensive gastropathy …”

“…3 Though PPIs are frequently prescribed in practice, PPI treatment has been shown to be ineffective in the primary prevention of upper gastrointestinal (GI) bleeding in patients with cirrhosis, including those related to varices and portal hypertensive gastropathy. 4…”

Proton Pump Inhibitor Use and Association with Spontaneous Bacterial Peritonitis in Patients with Cirrhosis and Ascites

“…A recent clinical trial demonstrated no improvement in the risk of portal hypertension bleeding for patients with cirrhosis on PPIs versus those not receiving PPIs. 5 Earlier studies postulated that ascites accumulation in patients with cirrhosis may result in gastroesophageal reflux (GERD) with progression to esophagitis and bleeding esophageal varices. 6 Newer data have refuted this evidence.…”