Proton pump inhibitor use and risk of hepatic encephalopathy: A multicentre study

IF 9.5 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY JHEP Reports Pub Date : 2024-04-26 DOI:10.1016/j.jhepr.2024.101104

Simon Johannes Gairing , Chiara Mangini , Lisa Zarantonello , Elise Jonasson , Henrike Dobbermann , Philippe Sultanik , Peter Robert Galle , Joachim Labenz , Dominique Thabut , Jens Uwe Marquardt , Patricia P. Bloom , Mette Munk Lauridsen , Sara Montagnese , Christian Labenz

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Abstract

Background & Aims

Data on the association between proton pump inhibitor (PPI) use and hepatic encephalopathy (HE) are conflicting, and data from multicentre studies are scarce. The aim of this study was to dissect the potential association between PPI use and minimal (MHE) and overt HE (OHE).

Methods

Data from patients with cirrhosis recruited at seven centres across Europe and the US were analysed. MHE was defined by the psychometric hepatic encephalopathy score (PHES). PPI use was recorded on the day of testing with PHES. Patients were followed for OHE development and death/liver transplantation.

Results

A total of 1,160 patients with a median MELD of 11 were included (Child-Pugh stages: A 49%/B 39%/C 11%). PPI use was noted in 58% of patients. Median follow-up time was 18.1 months, during which 230 (20%) developed an OHE episode, and 224 (19%) reached the composite endpoint of death/liver transplantation. In multivariable analyses, PPI use was neither associated with the presence of MHE at baseline nor OHE development during follow-up. These findings were consistent in subgroup analyses of patients with Child-Pugh A or B cirrhosis and after excluding patients with a history of OHE. PPI use was also not associated with a higher risk of OHE, neither in patients with an indication for treatment nor in patients without an indication.

Conclusions

PPI use is not associated with a higher risk of HE in patients with cirrhosis. Based on these findings, at present, a prescription should not be prohibited in case of a generally accepted indication.

Impact and implications

Data on the association between proton pump inhibitor (PPI) use and hepatic encephalopathy (HE) are conflicting. In this study, PPI use was not associated with a higher risk of minimal HE at baseline or overt HE during follow-up in patients with cirrhosis. Based on these findings, prescription of a PPI for a generally accepted indication should not be prohibited in patients with cirrhosis.

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使用质子泵抑制剂与肝性脑病的风险：一项多中心研究

背景& 目的有关使用质子泵抑制剂（PPI）与肝性脑病（HE）之间关系的数据相互矛盾，多中心研究的数据也很少。本研究旨在剖析使用质子泵抑制剂与轻微肝性脑病（MHE）和明显肝性脑病（OHE）之间的潜在关联。方法分析了在欧洲和美国七个中心招募的肝硬化患者的数据。MHE由心理测量肝性脑病评分（PHES）定义。在 PHES 测试当天记录 PPI 使用情况。结果共纳入了 1160 名 MELD 中位数为 11 的患者（Child-Pugh 分期：A 49%/B 39%/C 11%）。58%的患者使用过 PPI。中位随访时间为 18.1 个月，其间有 230 例（20%）患者发生了 OHE，224 例（19%）患者达到了死亡/肝移植的复合终点。在多变量分析中，使用 PPI 与基线 MHE 和随访期间发生 OHE 均无关。在对Child-Pugh A或B肝硬化患者进行亚组分析并排除有OHE病史的患者后，这些结果是一致的。无论是有治疗指征的患者还是无指征的患者，使用 PPI 也与较高的 OHE 风险无关。基于这些研究结果，目前在有公认适应症的情况下，不应禁止处方质子泵抑制剂（PPI）。在本研究中，使用质子泵抑制剂与肝硬化患者在基线时发生轻微肝性脑病或在随访期间发生明显肝性脑病的较高风险无关。基于这些研究结果，不应禁止肝硬化患者根据公认的适应症处方 PPI。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JHEP Reports GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

12.40

自引率

2.40%

发文量

161

审稿时长

36 days

期刊介绍： JHEP Reports is an open access journal that is affiliated with the European Association for the Study of the Liver (EASL). It serves as a companion journal to the highly respected Journal of Hepatology. The primary objective of JHEP Reports is to publish original papers and reviews that contribute to the advancement of knowledge in the field of liver diseases. The journal covers a wide range of topics, including basic, translational, and clinical research. It also focuses on global issues in hepatology, with particular emphasis on areas such as clinical trials, novel diagnostics, precision medicine and therapeutics, cancer research, cellular and molecular studies, artificial intelligence, microbiome research, epidemiology, and cutting-edge technologies. In summary, JHEP Reports is dedicated to promoting scientific discoveries and innovations in liver diseases through the publication of high-quality research papers and reviews covering various aspects of hepatology.

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