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Several studies have suggested that proton-pump inhibitors (PPIs) are associated with excess risk for spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites. In this observational study, researchers examined whether PPI use predisposes patients not only to SBP but also to hepatic encephalopathy. Among 865 patients with cirrhosis and ascites who were followed for 1 year, 39% used PPIs at baseline and another 12% started taking PPIs during follow-up.
After adjustment for confounding variables, current PPI use was associated with significantly higher risk for first-time hepatic encephalopathy (hazard ratio, 1.36), which developed in 22% of patients. PPI-related risk was even greater for developing overt (as opposed to mi…