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Use of proton pump inhibitors in chronic liver diseases

Proton pump inhibitors (PPIs) are among the most commonly prescribed classes of drugs among patients with cirrhosis. In many cases, these drugs may be prescribed inappropriately without clear indications and lead to harm (Table 1). Overall, PPI treatment in patients with cirrhosis is likely driven by concern regarding the risk for bleeding in these patients and from ambiguity in guidance regarding the duration of PPI treatment after bleeding episodes. Although benefits of PPI treatment have clearly been demonstrated in the management of peptic ulcer disease in patients with cirrhosis and in the immediate postendoscopic banding period to prevent rebleeding, evidence for the use of PPIs outside of these indications is lacking. Though PPIs are frequently prescribed in practice, PPI treatment has been shown to be ineffective in the primary prevention of upper gastrointestinal (GI) bleeding in patients with cirrhosis, including those related to varices and portal hypertensive gastropathy. PPI USE AND SPONTANEOUS BACTERIAL PERITONITIS