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Digestive Diseases and Sciences
Published in: Digestive Diseases and Sciences 1/2024

15-11-2023 | Proton Pump Inhibitors | Original Article

Proton Pump Inhibitors Increases Longitudinal Risk of Mortality, Decompensation, and Infection in Cirrhosis: A Meta-Analysis

Authors: Zhen Yu Wong, Jia Hong Koh, Mark Muthiah, Benjamin Koh, Elden Yen Hng Ong, Christen En Ya Ong, Kai Qi Ou, Wen Hui Lim, Darren Jun Hao Tan, Douglas Chee, Kewin Tien Ho Siah, Yujun Wong, Apichat Kaewdech, Karn Wijarnpreecha, Anand V. Kulkarni, Benjamin Nah, Daniel Q. Huang, Mazen Noureddin, Cheng Han Ng, Margaret Teng

Published in: Digestive Diseases and Sciences | Issue 1/2024

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Abstract

Background/Aims

Proton pump inhibitors (PPIs) are frequently prescribed to cirrhotic patients, but there is limited longitudinal evidence regarding their effects. This study aimed to assess the impact of PPIs on adverse events in cirrhotic patients.

Methods

A comprehensive search was conducted using the Medline and Embase databases to identify relevant articles. Pooled hazard ratios (HRs) using DerSimonian and Laird random-effects model were calculated to evaluate the risk of adverse events such as long-term mortality, hepatic decompensation, hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), and overall infection in cirrhotic patients with PPI use.

Results

The analysis included 28 studies with 260,854 cirrhotic patients. The prevalence of PPI use among cirrhotic patients was 55.93%. The use of PPIs was not significantly associated with short-term mortality in cirrhotic patients. However, long-term mortality (HR 1.321, 95% CI 1.103–1.581, P = 0.002), decompensation (HR 1.646, 95% CI 1.477–1.835, P < 0.001), HE (HR 1.968, 95% CI 1.372–2.822, P < 0.001), SBP (HR 1.751, 95% CI 1.649–1.859, P < 0.001), and infection (HR 1.370, 95% CI 1.148–1.634, P < 0.001) were significantly associated with PPI use. Sensitivity analysis with prospective studies yielded similar results.

Conclusion

PPIs should be reserved for appropriate indications at lowest effective dose for cirrhotic patients due to the potential harm.
Appendix
Available only for authorised users
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Metadata
Title
Proton Pump Inhibitors Increases Longitudinal Risk of Mortality, Decompensation, and Infection in Cirrhosis: A Meta-Analysis
Authors
Zhen Yu Wong
Jia Hong Koh
Mark Muthiah
Benjamin Koh
Elden Yen Hng Ong
Christen En Ya Ong
Kai Qi Ou
Wen Hui Lim
Darren Jun Hao Tan
Douglas Chee
Kewin Tien Ho Siah
Yujun Wong
Apichat Kaewdech
Karn Wijarnpreecha
Anand V. Kulkarni
Benjamin Nah
Daniel Q. Huang
Mazen Noureddin
Cheng Han Ng
Margaret Teng
Publication date
15-11-2023
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 1/2024
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-023-08150-6

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