Loading...
Several studies have suggested that proton-pump inhibitors (PPIs) might increase risk for complications of cirrhosis — in particular, hepatic encephalopathy and spontaneous bacterial peritonitis (NEJM JW Gen Med Nov 15 2016 and Hepatology 2016; 64:1265). One proposed mechanism is that suppression of gastric acid promotes bacterial overgrowth and promotes bacterial translocation from the gut; patients with cirrhosis might be especially vulnerable, given cirrhosis-associated immune dysfunction.
This retrospective multicenter study from Korea involved nearly 1500 patients with cirrhosis and histories of hepatic encephalopathy; 16% used high-dose PPIs, as defined by a metric that combined both daily PPI dose and duration of treatment. During med…