- In patients with advanced liver disease, proton pump inhibitor (PPI) use is significantly associated with an increased risk of developing hepatic encephalopathy (HE).
- High-quality prospective studies are needed to confirm this finding.
Why this matters
- Although the previous studies have shown the association between the PPI use and the risk of developing HE in patients with advanced liver disease, the evidence-based conclusions are controversial.
- Finding suggests that clinicians should strictly adhere to the indications for PPI use in patients with advanced liver disease.
- Meta-analysis of 9 studies (5 case-control [n=4342]; 4 cohort [n=188,053]) which were included after a search across PubMed, EMBASE and the Cochrane Library.
- Funding: None disclosed.
- In patients with advanced liver disease, PPI use vs no use was significantly associated with increased risk for HE (relative risk [RR], 2.08; 95% CI, 1.62-2.68; P<.00001 i>2, 80%).
- Pooled results of 5 case-control studies demonstrated that the risk for HE was significantly higher in PPI users vs non-users (OR, 2.58; 95% CI, 1.68-3.94; P<.00001 i>2, 72%).
- Pooled results of 4 cohort studies showed that PPI users were significantly at an increased risk for HE vs non-users (RR, 1.67; 95% CI, 1.30-2.14; P<.00001 i>2, 67%).
- In sensitivity analysis of patients without a history of HE episodes, the risk for HE was significantly higher in PPI users vs non-users (RR, 1.93; 95% CI, 1.33-2.80; P=.001; I2, 81%).
- Small number of studies were included.
- Heterogeneity among studies.