Proton Pump Inhibitor Use Is Associated with an Increased Frequency of New or Worsening Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation
Does proton pump inhibitor (PPI) use increase the rate of new or worsening hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation?
PPI usage is associated with new or worsening HE after TIPS.
Lewis, Douglas S., et al. Proton Pump Inhibitor Use is Associated with an Increased Frequency of New or Worsening Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation. Journal of Vascular and Interventional Radiology. February, 2019. Volume 30, Issue 2, 163-169.
Click here for abstract
Study design: Retrospective
Funding source: Self-funded or unfunded
Setting: Single institution
This retrospective review identified 284 patients who had undergone TIPS over a 1 year period, with a median follow-up time of 479 days. PPI types and dosage, in addition to dates of use were noted through review of the electronic medical record. Dates of new or worsening HE after TIPS were also identified. Mixed-effects negative binomial regression was used to test for an association between PPI usage and HE. The authors reported that, among the 284 patients analyzed in this study, there were 375 episodes of new or worsening HE, for an average of 1.32 episodes per person. Among 168 patients on PPIs chronically, there were 235 episodes of new or worsening HE in 106,101 person-days (0.81 episodes per person-year), 55 patients who were never on PPIs had 37 episodes (0.43/person-year), 61 patients intermittently on PPIs had 78 episodes (0.75/person-year), and 16 patients who never took PPIs had 25 episodes (0.26/person-year). Uni- and multivariate regression were performed. PPI usage was associated with a 3.34-fold increase in the rate of new or worsening HE and increasing age, higher MELD score, and history of HE or HE-preventative medication therapy before TIPS were also associated with increased HE after TIPS.
Zagum Bhatti, MD
Department of Radiology, Interventional Radiology Division
University of Texas Health Science Center at Houston, Houston, TX