Deleterious effect of proton pump inhibitors on the disease course of cirrhosis

Tamás Janka, Tamás Tornai, Brigitta Borbély, Dávid Tornai, István Altorjay, Mária Papp, Zsuzsanna Vitális

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVES: Proton pump inhibitors(PPIs) are widely prescribed to patients with liver cirrhosis. We hypothesized that long-standing PPI use is associated with spontaneous bacterial peritonitis(SBP) and accelerated development of disease-specific complications and liver-related death. METHODS: A 5-year follow-up observational cohort study assessed the impact of long-standing PPI use on the clinical course of cirrhosis in a large referral patient cohort. Three hundred fifty patients with cirrhosis (alcohol:69.1%, Child-Pugh stage A/B/C:206/108/36) were assigned to two groups: regular PPI users (n=196) and nonusers (n=154). Occurrence of SBP, decompensation events (ascites, hepatic encephalopathy and variceal bleeding), and liver-related death were assessed. RESULTS: Regular PPI use was associated with an increased cumulative probability of SBP compared to nonusers [55% vs. 24.8%, hazard ratio(HR):4.25; P=0.05], in patients without previous SBP episode (n=84). A similar association was found between regular PPI use and decompensation events. The risk of the development of a first decompensation was higher in regular PPI users compared with nonusers, in patients with compensated clinical stage at enrollment (HR: 2.81, P= 0.008, n=146). The risk of liver-related death was also significantly increased among regular PPI users (P<0.001). In multivariate Cox-regression analysis, regular PPI use (HR:2.81, P=0.003) and MELD score (HR:1.21, P<0.001) was an independent predictor of mortality. CONCLUSION: In the present follow-up cohort study, long-term PPI use was associated with the development of SBP and a progressive disease course in patients with cirrhosis that may have been caused by enhanced pathologic bacterial translocation, accelerated development of bacterial translocation-dependent disease-specific complications, and liver-related death.

Original languageEnglish
Pages (from-to)257-264
Number of pages8
JournalEuropean journal of gastroenterology & hepatology
Volume32
Issue number2
DOIs
Publication statusPublished - Feb 1 2020

Fingerprint

Proton Pump Inhibitors
Fibrosis
Peritonitis
Bacterial Translocation
Liver
Cohort Studies
Hepatic Encephalopathy
Ascites
Liver Cirrhosis
Observational Studies
Referral and Consultation
Regression Analysis
Alcohols
Hemorrhage
Mortality

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Deleterious effect of proton pump inhibitors on the disease course of cirrhosis. / Janka, Tamás; Tornai, Tamás; Borbély, Brigitta; Tornai, Dávid; Altorjay, István; Papp, Mária; Vitális, Zsuzsanna.

In: European journal of gastroenterology & hepatology, Vol. 32, No. 2, 01.02.2020, p. 257-264.

Research output: Contribution to journalArticle

Janka, Tamás ; Tornai, Tamás ; Borbély, Brigitta ; Tornai, Dávid ; Altorjay, István ; Papp, Mária ; Vitális, Zsuzsanna. / Deleterious effect of proton pump inhibitors on the disease course of cirrhosis. In: European journal of gastroenterology & hepatology. 2020 ; Vol. 32, No. 2. pp. 257-264.
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abstract = "OBJECTIVES: Proton pump inhibitors(PPIs) are widely prescribed to patients with liver cirrhosis. We hypothesized that long-standing PPI use is associated with spontaneous bacterial peritonitis(SBP) and accelerated development of disease-specific complications and liver-related death. METHODS: A 5-year follow-up observational cohort study assessed the impact of long-standing PPI use on the clinical course of cirrhosis in a large referral patient cohort. Three hundred fifty patients with cirrhosis (alcohol:69.1{\%}, Child-Pugh stage A/B/C:206/108/36) were assigned to two groups: regular PPI users (n=196) and nonusers (n=154). Occurrence of SBP, decompensation events (ascites, hepatic encephalopathy and variceal bleeding), and liver-related death were assessed. RESULTS: Regular PPI use was associated with an increased cumulative probability of SBP compared to nonusers [55{\%} vs. 24.8{\%}, hazard ratio(HR):4.25; P=0.05], in patients without previous SBP episode (n=84). A similar association was found between regular PPI use and decompensation events. The risk of the development of a first decompensation was higher in regular PPI users compared with nonusers, in patients with compensated clinical stage at enrollment (HR: 2.81, P= 0.008, n=146). The risk of liver-related death was also significantly increased among regular PPI users (P<0.001). In multivariate Cox-regression analysis, regular PPI use (HR:2.81, P=0.003) and MELD score (HR:1.21, P<0.001) was an independent predictor of mortality. CONCLUSION: In the present follow-up cohort study, long-term PPI use was associated with the development of SBP and a progressive disease course in patients with cirrhosis that may have been caused by enhanced pathologic bacterial translocation, accelerated development of bacterial translocation-dependent disease-specific complications, and liver-related death.",
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AU - Tornai, Tamás

AU - Borbély, Brigitta

AU - Tornai, Dávid

AU - Altorjay, István

AU - Papp, Mária

AU - Vitális, Zsuzsanna

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