Adverse outcomes of proton pump inhibitors in chronic liver disease: a systematic review and meta-analysis

Wang, Junna; Wu, Yangpeng; Bi, Qiu; Zheng, Xianglong; Zhang, Jingtao; Huang, Wenxiang

doi:10.1007/s12072-019-10010-3

Cited by 29 publications

(28 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The AUC is the best pharmacokinetic parameter predicting the magnitude of gastric acid suppression, thus reflecting the potential adverse clinical outcomes that depend on it, that is, hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP). In a recent meta‐analysis, the pooled odds ratio (OR) for HE and SBP in PPI users compared with non‐PPI users was 2.31, 95% CI 1.63‐3.28, and 1.72, 95% CI 1.42‐2.09 respectively 29 . Interestingly, all individual PPIs, except rabeprazole, showed an increased risk of HE occurrence 30 …”

Section: Discussionmentioning

confidence: 99%

Impact of proton pump inhibitors on cytochrome P450 activity assessed by ¹³C‐aminopyrine breath test in patients with cirrhosis

Rocco

Compare

Sgamato

et al. 2020

Aliment Pharmacol Ther

View full text Add to dashboard Cite

SummaryBackgroundChronic use of proton pump inhibitors (PPIs) in patients with impaired liver function may worsen cytochrome P450 (CYP450) activity, predisposing them to clinically relevant drug–drug interactions. The 13C‐aminopyrine breath test (13C‐ABT) is a non‐invasive tool to study CYP450‐dependent liver function.AimsTo assess 13C‐ABT modifications with different PPIs in patients with cirrhosisMethodsSixty consecutive patients with HCV‐related cirrhosis and indication to start PPI therapy were randomised to receive omeprazole 20 mg/day, esomeprazole 20 mg/day, lansoprazole 15 mg/day, pantoprazole 40 mg/day or rabeprazole 20 mg/day. 13C‐ABT was performed at baseline and on the 15th day of PPI therapy.ResultsAt baseline, mean values of max 13C% dose/h and 13C% cum dose at 120 minutes did not differ significantly among groups. On the 15th day of therapy, max 13C% dose/h and 13C% cum dose at 120 minutes did not significantly differ with respect to baseline for pantoprazole (P = 0.184 and P = 0.309, respectively) or rabeprazole (P = 0.536 and P = 0.286, respectively), but were significantly decreased on omeprazole (P = 0.013 and P = 0.015, respectively), esomeprazole (P = 0.009 and P = 0.001, respectively), and lansoprazole (P = 0.033 and P = 0.035, respectively).ConclusionsIn patients with cirrhosis, omeprazole, esomeprazole and lansoprazole inhibit microsomal activity while pantoprazole and rabeprazole do not have a significant impact. Should our data be confirmed in larger cohort studies, pantoprazole and rabeprazole could be safely recommended for patients with cirrhosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of proton pump inhibitors on cytochrome P450 activity assessed by ¹³C‐aminopyrine breath test in patients with cirrhosis

Rocco

Compare

Sgamato

et al. 2020

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

“…Accordingly, prophylactic medications for GIB, such as proton pump inhibitors (PPIs), are often prescribed in these patients, particularly when aspirin is indicated. However, the use of PPIs in cirrhotic patients has been related to increased risks of adverse events such as hepatic encephalopathy, spontaneous bacterial peritonitis, and possibly HCC and mortality (39,40). Therefore, the influence of aspirin use in cirrhotic patients with HBV or HCV infection may be much more complicated in realworld clinical practice, which warrants delicately designed RCTs to evaluate the potential benefits on HCC and risks of GIB.…”

Section: Figure 8 | Publication Bias Analysis (A)mentioning

confidence: 99%

Aspirin Use and the Incidence of Hepatocellular Carcinoma in Patients With Hepatitis B Virus or Hepatitis C Virus Infection: A Meta-Analysis of Cohort Studies

Li¹,

Wu²,

Yu³

2021

Front. Med.

View full text Add to dashboard Cite

Background: The association between aspirin use and the incidence of hepatocellular carcinoma (HCC) in patients with hepatitis B virus (HBV) or hepatitis C (HCV) virus infection remains not fully determined. A meta-analysis was performed to summarize the findings of cohort studies.Methods: Relevant cohort studies were retrieved via a search of PubMed Cochrane's Library and Embase databases. A random-effect model was used to pool the results. Subgroup analyses were performed to evaluate the influence of study characteristics on the association.Results: Seven cohort studies with 120,945 adult patients with HBV or HCV infection were included. Pooled results showed that aspirin use was independently associated with a reduced risk of HCC in these patients (risk ratio: 0.73, 95% confidence interval: 0.64 to 0.83, p < 0.001; I2 = 86%). Subgroup analyses showed that aspirin use was associated with a reduced HCC risk regardless of the viral type, age, sex, the diabetic, and cirrhotic status of the patients, and the follow-up durations. Moreover, consistent results were obtained in studies with and without adjustment of antiviral treatment and statin use. Pooled results of four studies showed that aspirin use was associated with an increased risk of gastrointestinal bleeding in these patients (risk ratio: 1.15, 95% confidence interval: 1.02 to 1.28, p = 0.02; I2 = 0%).Conclusions: Aspirin use was independently associated with a reduced risk of HCC in patients with HBV or HCV infection, whereas the risk of gastrointestinal bleeding may be increased. These results should be validated in clinical trials.

show abstract

“…The current study by Wang et al [4] sets the stage for further research to identify each piece of the pathophysiology puzzle. In the post-hoc analysis of a recently published randomized double blinded controlled trial of 17,598 PPI vs. non-PPI user (median follow-up of 3.01 years) that looked at the cardiovascular events as the primary outcome, it showed that all the alleged PPI-related adverse effects, except enteric infections, were not significantly different between PPI users and non-PPI users [11].…”

mentioning

confidence: 90%

“…In this issue, Wang et al [4] performed a systematic review and meta-analysis on five adverse clinical outcomes of PPIs in patients with chronic liver disease, including SBP, HE, infection, mortality and hepatocellular carcinoma (HCC). The authors showed that all five adverse events, except HCC (no conclusions could be drawn due to small number of studies), were associated with long-term PPI use.…”

mentioning

confidence: 99%

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

Mak

Fung

2020

Hepatol Int

View full text Add to dashboard Cite

Adverse outcomes of proton pump inhibitors in chronic liver disease: a systematic review and meta-analysis

Cited by 29 publications

References 26 publications

Impact of proton pump inhibitors on cytochrome P450 activity assessed by ¹³C‐aminopyrine breath test in patients with cirrhosis

Impact of proton pump inhibitors on cytochrome P450 activity assessed by ¹³C‐aminopyrine breath test in patients with cirrhosis

Aspirin Use and the Incidence of Hepatocellular Carcinoma in Patients With Hepatitis B Virus or Hepatitis C Virus Infection: A Meta-Analysis of Cohort Studies

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

Contact Info

Product

Resources

About

Adverse outcomes of proton pump inhibitors in chronic liver disease: a systematic review and meta-analysis

Cited by 29 publications

References 26 publications

Impact of proton pump inhibitors on cytochrome P450 activity assessed by 13C‐aminopyrine breath test in patients with cirrhosis

Impact of proton pump inhibitors on cytochrome P450 activity assessed by 13C‐aminopyrine breath test in patients with cirrhosis

Aspirin Use and the Incidence of Hepatocellular Carcinoma in Patients With Hepatitis B Virus or Hepatitis C Virus Infection: A Meta-Analysis of Cohort Studies

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

Contact Info

Product

Resources

About

Impact of proton pump inhibitors on cytochrome P450 activity assessed by ¹³C‐aminopyrine breath test in patients with cirrhosis

Impact of proton pump inhibitors on cytochrome P450 activity assessed by ¹³C‐aminopyrine breath test in patients with cirrhosis