Advanced liver disease: proton pump inhibitors tied to hepatic encephalopathy risk

  • Tantai XX & al.
  • World J Gastroenterol
  • 7 Jun 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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%).

Limitations

  • Small number of studies were included.
  • Heterogeneity among studies.