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Association of proton pump inhibitors with risk of hepatic encephalopathy in advanced liver disease: A meta-analysis.
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- Author(s): Tantai XX;Tantai XX; Yang LB; Yang LB; Wei ZC; Wei ZC; Xiao CL; Xiao CL; Chen LR; Chen LR; Wang JH; Wang JH; Liu N; Liu N
- Source:
World journal of gastroenterology [World J Gastroenterol] 2019 Jun 07; Vol. 25 (21), pp. 2683-2698.- Publication Type:
Journal Article; Meta-Analysis- Language:
English - Source:
- Additional Information
- Source: Publisher: Baishideng Publishing Group Country of Publication: United States NLM ID: 100883448 Publication Model: Print Cited Medium: Internet ISSN: 2219-2840 (Electronic) Linking ISSN: 10079327 NLM ISO Abbreviation: World J Gastroenterol Subsets: MEDLINE
- Publication Information: Publication: 2014- : Pleasanton, CA : Baishideng Publishing Group
Original Publication: Beijing : WJG Press, c1998- - Subject Terms: Hepatic Encephalopathy/*epidemiology ; Liver Cirrhosis/*complications ; Proton Pump Inhibitors/*adverse effects; Disease Progression ; Hepatic Encephalopathy/etiology ; Humans ; Liver Cirrhosis/pathology ; Observational Studies as Topic ; Prognosis ; Randomized Controlled Trials as Topic ; Risk Assessment ; Risk Factors
- Abstract: Background: Several studies have explored the association between the use of proton pump inhibitors (PPIs) and the risk of developing hepatic encephalopathy (HE) in patients with advanced liver disease. However, the evidence-based conclusions are controversial. We hypothesized that using PPIs may increase the risk of HE in patients with advanced liver disease. If confirmed, clinicians must strictly adhere to the indications for PPI treatment in this population.
Aim: To evaluate the pooled risk of HE in patients with advanced liver disease who use PPIs.
Methods: Three electronic databases (PubMed, EMBASE, and the Cochrane Library) were searched from the date of database inception through January 8, 2019 to identify comparative studies evaluating the association between PPI use and the risk of HE. Data from the included studies were extracted. The random-effects model was used for pooling risk estimates and the corresponding 95% confidence intervals (CIs). Subgroup and sensitivity analyses were also performed.
Results: In total, 4342 patients from five case-control studies and 188053 patients from four cohort studies were included in this analysis. In patients with advanced liver disease, PPI use was associated with an elevated risk of developing HE, with significant heterogeneity. The pooled odds ratio for case-control studies was 2.58 (95%CI: 1.68-3.94, I 2 = 72%). The pooled RR for cohort studies was 1.67 (95%CI: 1.30-2.14, I 2 = 67%). The results of the subgroup analyses suggested that the heterogeneity may be the result of differences in the study designs and the definitions of PPI use. The sensitivity and subgroup analyses did not alter our findings.
Conclusion: In patients with advanced liver disease, PPI use is associated with an elevated risk of HE. Future large prospective studies are needed to confirm this association.
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BMJ. 1998 Mar 28;316(7136):989-91. (PMID: 9550961) - Contributed Indexing: Keywords: Cirrhosis; Hepatic encephalopathy; Meta-analysis; Proton pump inhibitors; Systematic review
- Accession Number: 0 (Proton Pump Inhibitors)
- Publication Date: Date Created: 20190619 Date Completed: 20191216 Latest Revision: 20200225
- Publication Date: 20221213
- Accession Number: PMC6558434
- Accession Number: 10.3748/wjg.v25.i21.2683
- Accession Number: 31210719
- Source:
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