Proton Pump Inhibitors Are Associated With Minimal and Overt Hepatic Encephalopathy and Increased Mortality in Patients With Cirrhosis
Open accessAbstract
Minimal hepatic encephalopathy (MHE) is a subclinical cognitive impairment frequently observable in patients with cirrhosis. Proton pump inhibitors (PPIs) can contribute to small‐bowel bacterial overgrowth, but no study has investigated the link between PPIs and MHE. We investigated the relationship between MHE and PPI use as well as the role of PPI use in the development of overt HE and survival. Consecutive patients with cirrhosis (n = 310) were included in the study and followed up for 14.1 ± 12.3 months. At entry, MHE was diagnosed when the Psychometric Hepatic Encephalopathy Score was ≤–4. Data were analyzed by logistic regression for the factors associated with MHE and by time‐related models for overt HE development and survival. At inclusion, 131 out of 310 patients with cirrhosis (42%) were affected by MHE. One hundred and twenty‐five patients (40%) were using PPIs. The variables independently associated with the presence of MHE were PPI use, previous overt HE, low albumin, low sodium, and age. During follow‐up, the development of overt HE was higher (64% versus 25%, P < 0.001) and overall survival lower (41% versus 81%, P < 0.001) in PPI users than in nonusers. Variables independently associated with the development of overt HE were PPIs, history of overt HE, low albumin, MHE, and age, while variables independently associated with mortality were PPIs, development of overt HE, Model for End‐Stage Liver Disease score, low sodium, and age. Conclusion: The study identifies a potentially removable factor associated with the presence of MHE and related to the development of overt HE and survival in patients with liver cirrhosis.
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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 [88]
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Proton pump inhibitors and dysbiosis: current knowledge and aspects to be clarified
Bruno, G., Zaccari, P., Rocco, G., Scalese, G., Panetta, C., Porowska, B., Pontone, S., & Severi, C. (2019) · World Journal of Gastroenterology · doi:10.3748/wjg.v25.i22.2706 · Cited by 258 · see citing works
- Authors
- Nardelli, S., Gioia, S., Ridola, L., Farcomeni, A., Merli, M., & Riggio, O.
- Affiliations
- Sapienza University of Rome (IT)
- Corresponding author
- Nardelli, Silvia
- Venue
- Hepatology
- Published
- 2019-03-04
- Volume
- 70
- Issue
- 2
- Pages
- 640-649
- ISSN
- 0270-9139 (ISSN-L)
- 1527-3350
- OpenAlex
- W2921211225
- Cited by
- 109
- References
- 51
- Citations by year
- 2026: 4 · 2025: 15 · 2024: 13 · 2023: 14 · 2022: 16 · 2021: 18 · 2020: 15 · 2019: 13 · 2018: 1
- FWCI
- 7.35
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, other-oa)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
- Keywords
- proton pump inhibitors, minimal hepatic encephalopathy, overt hepatic encephalopathy, liver cirrhosis, mortality, small intestinal bacterial overgrowth, albumin, hyponatremia, Model for End-Stage Liver Disease, psychometric hepatic encephalopathy score
- MeSH terms
- Aged, Female, Hepatic Encephalopathy, Humans, Liver Cirrhosis, Male, Middle Aged, Prospective Studies, Survival Rate, Proton Pump Inhibitors
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