Use of proton pump inhibitors in chronic liver diseases

Li, Darrick K.; Chung, Raymond T.

doi:10.1002/cld.678

Cited by 14 publications

(4 citation statements)

References 23 publications

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“…PPIs inactivate NA + -K + -ATPase, thereby inhibiting gastric acid secretion, reducing the injury caused by gastric acid to the mucosa, and promoting postoperative ulcer healing[ 19 ]. Although reports have suggested that long-term application of PPIs might increase the occurrence of spontaneous peritonitis and hepatic encephalopathy in patients with liver cirrhosis[ 20 - 22 ], a recent clinical study determined that routine application of PPIs for 30 d after EVL was safe and could significantly reduce the upper gastrointestinal rebleeding and mortality rates of patients within 30 d of hospitalization[ 16 ]. Meanwhile, a recent meta-analysis also showed that PPI reduced the rebleeding rate of patients with liver cirrhosis and esophagogastric variceal bleeding by nearly 50% after endoscopic therapy.…”

Section: Discussionmentioning

confidence: 99%

Effect of aluminum phosphate gel on prevention of early rebleeding after ligation of esophageal variceal hemorrhage

Zhang¹,

Peng²,

Chen³

et al. 2021

WJGS

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BACKGROUND Liver cirrhosis is the main cause of portal hypertension. The leading cause of death in patients with liver cirrhosis is its most common complication, esophageal variceal bleeding (EVB). Endoscopic variceal ligation (EVL) is recommended by many guidelines to treat EVB and prevent rebleeding; however, esophageal ulcers occur after treatment. Delayed healing of ulcers and unhealed ulcers lead to high rebleeding and mortality rates. Thus, the prevention of early postoperative rebleeding is of great significance in improving the quality of life and prognosis of patients. AIM To evaluate the efficacy of aluminum phosphate gel (APG) plus a proton pump inhibitor (PPI) in the prevention of early rebleeding after EVL in patients with EVB. METHODS The medical records of 792 patients who were diagnosed with EVB and in whom bleeding was successfully stopped by EVL at Shenzhen People’s Hospital, Guangdong Province, China from January 2015 to December 2020 were collected. According to the study inclusion and exclusion criteria, 401 cases were included in a PPI-monotherapy group (PPI group), and 377 cases were included in a PPI and APG combination therapy (PPI + APG) group. We compared the incidence rates of early rebleeding and other complications within 6 wk after treatment between the two groups. The two-sample t -test, Wilcoxon rank-sum test, and chi-squared test were adopted for statistical analyses. RESULTS No significant differences in age, sex, model for end-stage liver disease score, coagulation function, serum albumin level, or hemoglobin level were found between the two groups. The incidence of early rebleeding in the PPI + APG group (9/337; 2.39%) was significantly lower than that in the PPI group (30/401; 7.48%) ( P = 0.001). Causes of early rebleeding in the PPI group were esophageal ulcer (3.99%, 16/401) and esophageal varices (3.49%, 14/401), while those in the PPI + APG group were also esophageal ulcers (5/377; 1.33%) and esophageal varices (4/377; 1.06%); such causes were significantly less frequent in the PPI + APG group than in the PPI group ( P = 0.022 and 0.024, respectively). The early mortality rate within 6 wk in both groups was 0%, which was correlated with the timely rehospitalization of all patients with rebleeding and the conduct of emergency endoscopic therapy. The incidence of adverse events other than early bleeding in the PPI + APG group (28/377; 7.43%) was significantly lower than that in the PPI group (63/401; 15.71%) ( P < 0.001). The incidence of chest pain in the PPI + APG group (9/377; 2.39%) was significantly lower than that in the PPI group (56/401; 13.97%) ( P < 0.001). The incidence of constipation in the PPI + APG group (16/377; 4.24%) was significantly higher than that in the PPI group (3/401; 0.75%) ( P = 0.00...

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Section: Discussionmentioning

confidence: 99%

Effect of aluminum phosphate gel on prevention of early rebleeding after ligation of esophageal variceal hemorrhage

Zhang¹,

Peng²,

Chen³

et al. 2021

WJGS

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“…Proton pump inhibitors (PPIs) reduce gastric pH and motility and promote small intestinal bacterial overgrowth. 83 PPIs (especially prolonged use) increase the risk of infections, such as SBP and C. difficile in cirrhosis, and adversely affect the outcomes. 84 85 86 Hence, it may be prudent to avoid long-term PPIs in patients with cirrhosis.…”

Section: Primary Preventionmentioning

confidence: 99%

Early Diagnosis and Prevention of Infections in Cirrhosis

et al. 2022

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Cirrhosis is a risk factor for infections. Majority of hospital admissions in patients with cirrhosis are due to infections. Sepsis is an immunological response to an infectious process that leads to end-organ dysfunction and death. Preventing infections may avoid the downstream complications and early diagnosis of infections may improve the outcomes. In this review, we discuss the pathogenesis, diagnosis, and biomarkers of infection, as well as incremental preventive strategies for infections and sepsis and consequent organ failures in cirrhosis. Strategies for primary prevention include reducing gut translocation by selective intestinal decontamination, avoiding unnecessary proton pump inhibitors’ use, appropriate use of beta-blockers and vaccinations for viral diseases, including coronavirus disease-2019. Secondary prevention includes early diagnosis and timely and judicious use of antibiotics to prevent organ dysfunction. Organ failure support constitutes tertiary intervention in cirrhosis. In conclusion, infections in cirrhosis are potentially preventable with appropriate care strategies to then enable to improve outcomes.

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“…PPIs are extensively used in individuals with cirrhosis without clear indications 2 . There have been concerns about the PPIs use in cirrhotic patients.…”

mentioning

confidence: 99%

Letter: confounders and outcomes in studies of beta‐blockers in liver disease—role of PPIs?

Kılınçalp

Papachrysos

2021

Aliment Pharmacol Ther

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Use of proton pump inhibitors in chronic liver diseases

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/10-6-reading-li.html a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/10-6-interview-chung.html the interview with the author

Cited by 14 publications

References 23 publications

Effect of aluminum phosphate gel on prevention of early rebleeding after ligation of esophageal variceal hemorrhage

Effect of aluminum phosphate gel on prevention of early rebleeding after ligation of esophageal variceal hemorrhage

Early Diagnosis and Prevention of Infections in Cirrhosis

Letter: confounders and outcomes in studies of beta‐blockers in liver disease—role of PPIs?

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