ArticleGastroenterology2022
The Association Between Proton Pump Inhibitor Exposure and Key Liver-Related Outcomes in Patients With Cirrhosis: A Veterans Affairs Cohort Study.
Article in Gastroenterology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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Who cites it
22 citing papers in PubMed, 53 citations in OpenAlex.
- Therapeutic potential ofPharmaceutical biology · 2026Review
- Letter on 'Altered Pathogen Spectrum of Spontaneous Bacterial Peritonitis in Patients Treated With Proton Pump Inhibitors'.Alimentary pharmacology & therapeutics · 2026Article
- KASL clinical practice guidelines for liver cirrhosis: Ascites and related complications 2026.Clinical and molecular hepatology · 2026Article
- Altered Pathogen Spectrum of Spontaneous Bacterial Peritonitis in Patients Treated With Proton Pump Inhibitors.Alimentary pharmacology & therapeutics · 2026Article
- Spontaneous Bacterial Peritonitis Is Associated With High Mortality, Which Interacts With Antibiotic Prophylaxis in a National Cirrhosis Cohort.Alimentary pharmacology & therapeutics · 2026Article
- The diagnosis and management of portal hypertension in cirrhosis: The Gastroenterological Society of Australia consensus.Hepatology communications · 2026Article
- Proton Pump Inhibitor Use in Patients With Cirrhosis and Its Association With Spontaneous Bacterial Peritonitis.The Journal of pharmacy technology : jPT : official publication of the Association of Pharmacy Technicians · 2025Article
- [Clinical treatment controversies and progress in liver cirrhosis: an evidence-based medicine perspective from managing portal hypertension to preventing complications].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025Article
- Proton Pump Inhibitor Use Following Esophageal Variceal Ligation and Its Impact on Clinical Outcomes: Real-World Data from the TriNetX Global Collaborative Network.Diagnostics (Basel, Switzerland) · 2025Article
- Proton pump inhibitor use and pancreatic risk: evidence from the UK biobank participants and animal experiments.Frontiers in pharmacology · 2025Article
- The acidic microenvironment in the perisinusoidal space critically determines bile salt-induced activation of hepatic stellate cells.Communications biology · 2024Article
- GLP-1 Receptor Agonists and Risk for Cirrhosis and Related Complications in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease.JAMA internal medicine · 2024Article
- The Use of Proton Pump Inhibitors in Patients with Liver Cirrhosis: Real Life Experience.Journal of clinical medicine · 2024Article
- Proton pump inhibitor use is associated with increased liver steatosis.Biomedical reports · 2024Article
- An Emulated Clinical Trial of Deprescribing Proton Pump Inhibitors in Patients With Cirrhosis.The American journal of gastroenterology · 2024Article
- Risks of Proton Pump Inhibitors in Patients with Cirrhosis: Please Peruse the Indications.Digestive diseases and sciences · 2024Article
- Forgettable in the care of liver cirrhosis: the unseen culprits of progression from bad to worse.Przeglad gastroenterologiczny · 2024Review
- [Optimal Use of Proton Pump Inhibitors and Potassium-competitive Acid Blockers].The Korean journal of helicobacter and upper gastrointestinal research · 2023Review
- Association between statin exposure and short-term mortality in patients with high-grade acute-on-chronic liver failure.JHEP reports : innovation in hepatology · 2023Article
- Management of decompensated liver cirrhosis in the surgical intensive care unit.Hepatobiliary surgery and nutrition · 2023Article
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
Abstract
BACKGROUND &
aimsThe impact of proton pump inhibitory (PPI) medications on adverse outcomes in cirrhosis remains controversial. We aimed to evaluate the association between PPI exposure and all-cause mortality, infection, and decompensation in a large national cohort.
methodsThis was a retrospective study of patients with cirrhosis in the Veterans Health Administration. PPI exposure was classified as a time-updating variable from the index time of the cirrhosis diagnosis. Inverse probability treatment weighting-adjusted Cox regression was performed with additional adjustment for key time-varying covariates, including cardiovascular comorbidities, gastrointestinal bleeding (GIB), and statin exposure.
resultsThe study included 76,251 patients, 23,628 of whom were on a PPI at baseline. In adjusted models, binary (yes/no) PPI exposure was associated with reduced hazard of all-cause mortality in patients with hospitalization for GIB (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.84-0.91; P < .001) but had no significant association in all others (HR, 0.99; 95% CI, 0.97-1.02; P = .58). However, cumulative PPI exposure was associated with increased mortality in patients without hospitalization for GIB (HR, 1.07 per 320 mg-months [omeprazole equivalents]; 95% CI, 1.06-1.08; P < .001). PPI exposure was significantly associated with severe infection (HR, 1.21; 95% CI, 1.18-1.24; P < .001) and decompensation (HR, 1.64; 95% CI, 1.61-1.68; P < .001). In a cause-specific mortality analysis, PPI exposure was associated with increased liver-related mortality (HR, 1.23; 95% CI, 1.19-1.28) but with decreased nonliver-related mortality (HR, 0.88; 95% CI, 0.85-0.91).
conclusionsPPI exposure is associated with increased risk of infection and decompensation in cirrhosis, which may mediate liver-related mortality. However, PPI use was associated with reduced all-cause mortality in those with prior GIB, suggesting benefit in the presence of an appropriate indication.
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