Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2019; 25(21): 2675-2682
Published online Jun 7, 2019. doi: 10.3748/wjg.v25.i21.2675
Proton pump inhibitor use increases hepatic encephalopathy risk: A systematic review and meta-analysis
Yun-Jie Ma, Zong-Xun Cao, Yong Li, Shun-Yi Feng
Yun-Jie Ma, Zong-Xun Cao, Yong Li, Shun-Yi Feng, Emergency Department, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
Author contributions: Ma YJ and Cao ZX contributed to conception and design of the study; Ma YJ, Cao ZX, and Feng SY contributed to acquisition of data; Cao ZX, Li Y, and Feng SY analyzed and interpreted the data; Ma YJ drafted the article; Li Y critically revised the manuscript; all authors approved the final version to be published.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: This systematic review was performed in accordance with the standards set forth by the statement from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yong Li, MD, Chief Doctor, Emergency Department, Cangzhou Central Hospital, No. 16, Xinhua Road, Yunhe Qu, Cangzhou 061000, Hebei Province, China. ly13333367871@hotmail.com
Telephone: +86-13333367871 Fax: +86-0317-2075685
Received: March 21, 2019
Peer-review started: March 21, 2019
First decision: April 4, 2019
Revised: April 24, 2019
Accepted: May 8, 2019
Article in press: May 8, 2019
Published online: June 7, 2019
Abstract
BACKGROUND

Several studies have been conducted to explore the association between the use of proton pump inhibitors (PPIs) and hepatic encephalopathy (HE) risk in patients with liver cirrhosis. However, their results are controversial.

AIM

To perform a systematic review and meta-analysis to evaluate the HE risk among PPI users.

METHODS

A systematic search on PubMed, Web of Science, EMBase, and ScienceDirect databases was conducted up to December 31, 2018 for eligible studies involving PPI use and HE risk. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the fixed or random effects model. Publication bias was evaluated using Begg’s test, Egger’s test, and trim-and-fill method.

RESULTS

Seven studies with 4574 patients were included in the present meta-analysis. The meta-analysis results indicated a significant association between the PPI use and HE risk (OR = 1.50; 95%CI: 1.25-1.75) with low heterogeneity (I2 = 14.2%, P = 0.321). Although publication bias existed when Egger’s tests were used (P = 0.005), the trim-and-fill method verified the stability of the pooled result. Sensitivity analyses suggested that the results of this meta-analysis were robust.

CONCLUSION

The current evidence indicates that PPI use increases HE risk in patients with liver cirrhosis. Further studies with a large data set and well-designed models are needed to validate our findings.

Keywords: Proton pump inhibitors, Hepatic encephalopathy, Meta-analysis

Core tip: Several studies have been conducted to explore the association between the use of proton pump inhibitors (PPIs) and hepatic encephalopathy (HE) risk in patients with liver cirrhosis. However, their results are controversial. The current evidence indicates that PPI use increases HE risk in patients with liver cirrhosis. Physicians should ban PPI use in patients with liver cirrhosis when they are used without specific indications.