Proton pump inhibitors as a risk factor for hepatic encephalopathy and spontaneous bacterial peritonitis in patients with cirrhosis with ascites

Dam, Gitte; Vilstrup, Hendrik; Watson, Hugh; Jepsen, Peter

doi:10.1002/hep.28737

Cited by 190Liver Disease and TransplantationAbdominal vascular conditions and treatmentsGastrointestinal Bleeding Diagnosis and Treatment

Proton pump inhibitors as a risk factor for hepatic encephalopathy and spontaneous bacterial peritonitis in patients with cirrhosis with ascites

Dam, Gitte, Vilstrup, Hendrik, Watson, Hugh, Jepsen, Peter·2016·Hepatology

DOI 10.1002/hep.28737

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Abstract

Proton pump inhibitors (PPIs) may be a risk factor for hepatic encephalopathy (HE) in patients with cirrhosis, possibly through 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 patients with cirrhosis 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 nonusers of PPIs. At inclusion, 39% of the 865 patients with cirrhosis 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 versus 25% for those who did not. The confounder‐adjusted hazard ratio (HR) of HE for current PPI use versus current nonuse was 1.36 (95% confidence interval [CI], 1.01‐1.84). The HR for overt HE was higher (adjusted HR = 1.88; 95% CI, 1.21‐1.91). During the follow‐up, 86 patients developed SBP. The adjusted HR of SBP for current PPI users versus nonusers was 1.72 (95% CI, 1.10‐2.69). 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. (H epatology 2016;64:1265‐1272)

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PPI-induced dysbiosis may represent a risk factor for hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP) in cirrhotic patients.
“PPI-induced dysbiosis may represent a risk factor for hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP) in cirrhotic patients[88-90].”
From Proton pump inhibitors and dysbiosis: current knowledge and aspects to be clarified (2019) · cites this paper as [90]

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A222 ASSOCIATION BETWEEN PROTON PUMP INHIBITOR USE AND DEVELOPMENT OF HEPATIC ENCEPHALOPATHY AND SPONTANEOUS BACTERIAL PERITONITIS IN HOSPITALIZED PATIENTS WITH CIRRHOSIS
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A70 ASSOCIATION BETWEEN PROTON PUMP INHIBITOR USE IN HOSPITALIZED CIRRHOTICS AND DEVELOPMENT OF HEPATIC ENCEPHALOPATHY AND SPONTANEOUS BACTERIAL PERITONITIS
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Association Between Proton Pump Inhibitor Use and Spontaneous Bacterial Peritonitis or Hepatic Encephalopathy in Cirrhotic Patients: A Systematic Review and Meta-analysis
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Are proton pump inhibitors a threat for spontaneous bacterial peritonitis and hepatic encephalopathy in cirrhosis? Not so fast
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Authors: Dam, G., Vilstrup, H., Watson, H., & Jepsen, P.
Affiliations: Aarhus University Hospital (DK)
Sanofi (France) (FR)
Corresponding author: Dam, Gitte
ORCID: Dam, Gitte
Vilstrup, Hendrik
Watson, Hugh
Jepsen, Peter
Venue: Hepatology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2016-08-24
Volume: 64
Issue: 4
Pages: 1265-1272
ISSN: 0270-9139 (ISSN-L)
1527-3350
DOI: 10.1002/hep.28737
OpenAlex: W2511041727
Cited by: 190
References: 26
Citations by year: 2026: 8 · 2025: 16 · 2024: 11 · 2023: 19 · 2022: 18 · 2021: 18 · 2020: 16 · 2019: 32 · 2018: 30 · 2017: 17 · 2016: 5
FWCI: 20.14
Type: journal article
Language: en
Open access: closed
Licence: doi.wiley.com/10.1002/tdm_license_1.1 (tdm)
Locations: Hepatology (publishedVersion)
PubMed (publishedVersion)
Scopus (Elsevier) (submittedVersion)
Topics: Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
Keywords: proton pump inhibitors, hepatic encephalopathy, spontaneous bacterial peritonitis, liver cirrhosis, ascites, gut bacterial translocation, drug safety, risk factors
MeSH terms: Aged, Ascites, Bacterial Infections, Female, Hepatic Encephalopathy, Humans, Liver Cirrhosis, Male, Middle Aged, Peritonitis, Risk Factors, Proton Pump Inhibitors

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Proton pump inhibitors as a risk factor for hepatic encephalopathy and spontaneous bacterial peritonitis in patients with cirrhosis with ascites

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