Proton pump inhibitor treatment is associated with the severity of liver disease and increased mortality in patients with cirrhosis

Dultz, G.; Piiper, Albrecht; Zeuzem, Stefan; Kronenberger, Bernd; Waidmann, Oliver

doi:10.1111/apt.13061

Cited by 100 publications

(117 citation statements)

References 29 publications

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“…Similarly, in our study we confirmed that many patients (63.6%) had not clear indication for taking PPI. Other studies have reported similar frequencies of inappropriate indication of PPI, range from 50% to 78.3% (12,26) .…”

Section: Discussionmentioning

confidence: 53%

Proton Pump Inhibitors Increase the Overall Risk of Developing Bacterial Infections in Patients With Cirrhosis

Lázaro-Pacheco

Servín-Caamaño

Pérez-Hernández

et al. 2018

Arq. Gastroenterol.

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-Background -Acid suppression has been associated with adverse events; such as, enteric infections. Proton pump inhibitors (PPI) are frequently prescribed in patients with cirrhosis, but is unclear if PPI are associated with the development of bacterial infections in these patients. Objective -To assess the impact of PPI intake on the development of bacterial, viral and fungal infections in patients with cirrhosis. Methods -An observational, retrospective, historic cohort study. The exposed cohort included patients with cirrhosis with chronic use of PPI. The non-exposed cohort had not been using PPI. The follow-up period was 3 years, searching in the medical records for any events of bacterial infection confirmed by bacteriological culture. Results -One hundred and thirteen patients met the selection criteria, 44 (39%) had chronic use of PPI; of them, 28 (63.6%) patients had not a clear clinical indication to justify the prescription of PPI. Twenty four (21.2%) patients developed bacterial infections during the follow-up period. In the univariate analysis, decompensated cirrhosis (Child B/C), presence of ascites, history of variceal bleeding, and chronic consumption of PPI were risk factors related to the development of infections. But, in the adjusted multivariate analysis only the chronic use of PPI was associated with development of infections (RR=3.6; 95% CI=1.1-12.3; P=0.04). Conclusion -There is an over-prescription of PPI without a justified clinical indication. The long-term consumption of PPI in patients with cirrhosis is associated with the development of bacterial infections; therefore these drugs must be carefully prescribed in this specific population. HEADINGS -Proton pump inhibitors, adverse effects. Inappropriate prescribing. Liver cirrhosis. Risk assessment.Declared conflict of interest of all authors: Fátima Higuera-de la Tijera has received fees for serving as a speaker for Laboratorios Liomont. The other authors have not conflict of interest to declare. None of the other researchers involved in this study have received fees for serving as a speaker, consultant or as advisory board member for any organization. Disclosure of funding: no funding received

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Section: Discussionmentioning

confidence: 53%

Proton Pump Inhibitors Increase the Overall Risk of Developing Bacterial Infections in Patients With Cirrhosis

Lázaro-Pacheco

Servín-Caamaño

Pérez-Hernández

et al. 2018

Arq. Gastroenterol.

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“…A significant proportion of cirrhotic patients are prescribed for PPIs [1]. The indication for PPI prescription in many of these patients is weak or unclear [2,3], in their study, Bajaj et al…”

Section: Introductionmentioning

confidence: 99%

Insights to Indications and Harm of Proton Pump Inhibitors Usage in Patients with Liver Cirrhosis

Wadea¹

2017

GHOA

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“…In a recent study, Dultz et al 26 found coincidence between PPI treatment in cirrhotic patients and higher model of end-stage liver disease scores as well as ascites. Furthermore, the use of PPIs was an independent predictor of mortality in these subjects.…”

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confidence: 95%

Overuse of proton pump inhibitors

Ksiądzyna¹,

Szeląg²,

Paradowski³

2015

Polish Archives of Internal Medicine

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Proton pump inhibitor treatment is associated with the severity of liver disease and increased mortality in patients with cirrhosis

Abstract: SUMMARY BackgroundProton pump inhibitors (PPI) are widely used in patients with liver diseases. Within the last years, there have been concerns about the PPI use as they may promote infections in patients with cirrhosis.

Cited by 100 publications

References 29 publications

Proton Pump Inhibitors Increase the Overall Risk of Developing Bacterial Infections in Patients With Cirrhosis

Proton Pump Inhibitors Increase the Overall Risk of Developing Bacterial Infections in Patients With Cirrhosis

Insights to Indications and Harm of Proton Pump Inhibitors Usage in Patients with Liver Cirrhosis

Overuse of proton pump inhibitors

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