Most Read Articles
17 Nov 2017
Total intravenous anaesthesia with propofol yields better survival compared with volatile anaesthetics (VA) for oesophageal cancer surgery, a recent retrospective observational study has found.
06 Sep 2018
Suicide appears to be more common in patients with cancers of the digestive system, especially in those with pancreatic and oesophageal cancers, a recent study has found.
08 Sep 2018
Use of statins may reduce the severity of acute pancreatitis (AP) seen in the decrease of overall incidence of multisystem organ failure (MSOF) and new MSOF, suggests a recent study.
12 Sep 2018
Hospitalization for acute biliary pancreatitis in elderly patients is likely to lead to adverse clinical outcomes, according to a study.

Excessive PPI use accelerates liver disease progression in chronic HCV patients

03 Dec 2017

Excessive and indiscriminate use of proton pump inhibitors (PPIs) may have perilous consequences for patients with chronic hepatitis C virus (HCV) infection, with a recent study showing that such pattern of exposure is associated with increased risks of progression of chronic liver disease to cirrhosis, hepatic decompensation and hepatocellular carcinoma.

The study included 11,526 HCV-infected veterans (mean age 53 years) who received HCV treatment, among whom 5,752 were PPI users. None of the patients had HIV coinfection, positive HBsAg and baseline gastro-oesophageal varices, among others. PPI use was measured using cumulative defined daily dose.

Multivariate Cox regression analysis found PPI exposure to be independently associated with an increased risk of developing cirrhosis (hazard ratio [HR], 1.32; 95 percent CI, 1.17 to 1.49). The cumulative probability of cirrhosis over 10 years of follow-up was significantly higher in patients who received PPI therapy (p<0.001), with the risk of cirrhosis increasing in a dose-dependent manner (p=0.003). The association was maintained through a sensitivity analysis that included only patients who achieved sustained virologic response and excluded those with alcohol abuse/dependence.

PPI use also increased the risks of hepatic decompensation by more than threefold (HR, 3.79; 2.58 to 5.57) and hepatocellular carcinoma by twofold (HR, 2.01; 1.50 to 2.70).

PPIs have been shown to substantially alter the composition of the gut microbiota in healthy individuals. Researchers postulated that the drugs may accelerate the progression of liver disease and promote the development of complications of cirrhosis by further exacerbating the dysbiosis associated with liver disease itself, leading to increased levels of pathogenic bacteria and bacterial translocation.

The present data underscore the importance of carefully assessing the use of PPIs in chronic HCV patients, researchers said. Additional studies with histological and clinical endpoints, as well as animal studies, are needed to elucidate the effect of long-term PPI use on the pathophysiological mechanisms of hepatic fibrosis.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Gastroenterology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
17 Nov 2017
Total intravenous anaesthesia with propofol yields better survival compared with volatile anaesthetics (VA) for oesophageal cancer surgery, a recent retrospective observational study has found.
06 Sep 2018
Suicide appears to be more common in patients with cancers of the digestive system, especially in those with pancreatic and oesophageal cancers, a recent study has found.
08 Sep 2018
Use of statins may reduce the severity of acute pancreatitis (AP) seen in the decrease of overall incidence of multisystem organ failure (MSOF) and new MSOF, suggests a recent study.
12 Sep 2018
Hospitalization for acute biliary pancreatitis in elderly patients is likely to lead to adverse clinical outcomes, according to a study.