Should proton pump inhibitors be used for glucocorticoid-related upper gastrointestinal bleeding prevention in patients with autoimmune liver disease? A real-world cohort study.

Background and aims: Glucocorticoids (GCs) as a key therapeutic option for autoimmune liver diseases (AILDs) are associated with an increased risk of upper gastrointestinal bleeding (UGIB). Proton pump inhibitors (PPIs) are widely used for the prevention and treatment of drug-related UGIB. However, it is unclear whether PPI can be used for the prevention of GC-related UGIB in patients with AILD. The aim of the study was to identify risk factors for UGIB and evaluate the prophylactic efficacy of PPI in patients with AILD undergoing GC. Methods: We retrospectively compared the occurrence of UGIB and PPI use in patients with AILD receiving GC between January 2005 and May 2025. Univariate and multivariate Cox regression were analyzed to identify independent influencing factors. Propensity score matching (PSM) was utilized to evaluate the prophylactic effect of PPI administration at different time points. Results: A total of 364 patients with AILD treated with GC were included with a median follow-up duration of 29 months. Thirty-two patients (8.8%) experienced UGIB. Compared to patients without UGIB, the UGIB group had a higher proportion of PBC+AIH (90.6% vs. 64.8%; Conclusions: In our real-world cohort, PPI use does not prevent GC-related UGIB among patients with AILD and may even be associated with a higher bleeding risk; however, this observed association is likely driven by confounding factors and should not be interpreted as a causal relationship.