Proton pump inhibitors in chronic liver disease: accomplice or bystander?

Excerpt

Since the introduction of omeprazole in 1989, proton pump inhibitors (PPIs) have revolutionized the medical therapy for patients with upper gastrointestinal disorders. Initially developed as a treatment for reflux esophagitis, these inhibitors of gastric acid secretion have subsequently been used in a wide array of both acid-related and non-acid related disorders. For instance, short-term PPI therapy is indicated in eradication of Helicobacter pylori infection, treatment of peptic ulcer disease, stress ulcer prophylaxis in high risk patients, and following endoscopic treatment of a high-risk peptic ulcer bleeding and gastroesophageal varices. Long-term PPI therapy is indicated in treatment of severe erosive esophagitis, Barrett’s esophagus, Zollinger–Ellison syndrome, PPI-responsive gastro-esophageal reflux disease, and prevention of gastrointestinal bleeding in high-risk individuals taking ulcerogenic medications. With the initial seemingly excellent safety profile, the use of PPIs have been further broadened, inevitably leading to inappropriate PPI use. …