Proton Pump Inhibitors as a Risk Factor for Hepatic Encephalopathy and Spontaneous Bacterial Peritonitis in Cirrhosis Patients With Ascites.
Hepatology. 2016 Jul 30;
Authors: Dam G, Vilstrup H, Watson H, Jepsen P
Proton pump inhibitors (PPIs) may be a risk factor for hepatic encephalopathy (HE) in cirrhosis patients, possibly via translocation of gut bacteria, which can also lead to spontaneous bacterial peritonitis (SBP). We examined the associations between PPIs and development of HE or SBP in cirrhosis patients with ascites. We used data from three 1-year trials of satavaptan for ascites control. We used Cox regression to compare HE and SBP rates between users and non-users of PPIs. At inclusion, 39% of the 865 cirrhosis patients with ascites used PPIs, 52% used them at some point during the follow-up, and the proportion of current users was always in the 30%-39% range. There were 189 first-time HE episodes during the follow-up, and the cumulative 1-year risk was 31% for those who used PPIs at baseline vs. 25% for those who did not. The confounder-adjusted hazard ratio of HE for current PPI use vs. current non-use was 1.36 (95% CI 1.01 to 1.84). The hazard ratio for overt HE was higher (adjusted hazard ratio = 1.88, 95% CI 1.21 to 1.91). During the follow up 86 patients developed SBP. The adjusted hazard ratio of SBP for current PPI users vs. non-users was 1.72 (95% CI 1.10 to 2.69).
CONCLUSION: PPIs were used by 52% of this international cirrhosis cohort during a 1-year period and was a risk factor for developing HE and SBP. These findings are consistent with the hypothesis that PPIs may increase translocation of gut bacteria. This article is protected by copyright. All rights reserved.
PMID: 27474889 [PubMed - as supplied by publisher]