illnesshacker: Medical information and health advice you can trust.

Proton Pump Inhibitors linked to liver disease, researchers find

Proton Pump Inhibitors linked to liver disease, researchers find?Researchers have found evidence that use of proton pump inhibitors (PPIs) may cause changes to gut bacteria that can promote liver disease.

They also showed a link between liver damage from alcohol abuse and use of PPIs.

Through a series of experiments in mice and humans, the team from University of California San Diego School of Medicine found that the absence of gastric acid promotes the growth of Enterococcus bacteria in the intestine.

The bacteria can then move to the liver, where they exacerbate inflammation and worsen chronic liver disease, the researchers said.

In mouse models that mimic human alcoholic liver disease, the researchers used either genetic engineering or a PPI to block gastric acid production, then analysed stool samples to look at the gut microbiome.

The increase in Enterococcus bacteria in the mice with acid suppression were found to increase the progression of alcohol-induced liver disease, non-alcoholic fatty liver disease (NAFLD) and steatohepatitis.

In a separate study of 4,830 patients with a diagnosis of chronic alcohol abuse — 1,024 active PPI users, 745 were previous users, and 3061 who had never used PPIs — the researchers also found a link between PPI intake and increased stool concentrations of Enterococcus.

They also reported that the rate of liver disease in people who chronically abuse alcohol was 8.3% higher for those who actively use PPIs compared with those who never used the medicines.

Study leader Bernd Schnabl, associate professor of gastroenterology, said: “Our stomachs produce gastric acid to kill ingested microbes, and taking a medication to suppress gastric acid secretion can change the composition of the gut microbiome.

You Might Also Like Nicardipine; Uses, Contraindications, Dosage, Side Effects, Interactions

“Our findings indicate that the recent rise in use of gastric acid-suppressing medications might have contributed to the increased incidence of chronic liver disease.

“We believe clinicians should consider withholding medications that suppress gastric acid unless there is a strong medical indication.”

Collected

References

^[1] Dworzynski K, Pollit V, Kelsey A et al. Management of acute upper gastrointestinal bleeding: summary of NICE guidance. The BMJ 2012;344:e3412. doi: 10.1136/bmj.e3412

^[2] Ford AC & Moayyedi P. Dyspepsia. The BMJ 2013;347:f5059. doi: 10.1136/bmj.f5059

^[3] Graham DY & Fischbach L. Helicobacter pylori treatment in the era of increasing antibiotic resistance. Gut 2010;59:1143–1153. doi: 10.1136/gut.2009.192757

^[4] Laine L. GI risk and risk factors of NSAIDs. J Cardiovasc Pharmacol 2006;47:S60–66. PMID: 16785831

^[5] Fitzgerald RC, di Pietro M, Ragunath K et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut 2014;63:7–42. doi: 10.1136/gutjnl-2013-305372

^[6] Forgacs I & Loganayagam A. Overprescribing proton pump inhibitors. The BMJ 2008;336:2–3. doi: 10.1136/bmj.39406.449456.BE

^[7] Neumann I, Letelier LM, Rada G et al. Comparison of different regimens of proton pump inhibitors for acute peptic ulcer bleeding. Cochrane Database Syst Rev 2013;(6):CD007999. doi: 10.1002/14651858.CD007999

^[8] Hollingworth S, Duncan EL & Martin JH. Marked increase in proton pump inhibitors use in Australia. Pharmacoepidemiol Drug Saf 2010;19:1019–1024. doi: 10.1002/pds.1969

^[9] Haastrup P, Paulsen MS, Zwisler JE et al. Rapidly increasing prescribing of proton pump inhibitors in primary care despite interventions: a nationwide observational study. Eur J Gen Pract 2014;20:290–293. doi: 10.3109/13814788.2014.905535

^[10] McGowan B, Bennett K, Barry M et al. The utilisation and expenditure of medicines for the prophylaxis and treatment of osteoporosis. Ir Med J 2008;101:38–41. PMID: 18450246

^[11] Ribolsi M, Savarino E, De Bortoli N et al. Reflux pattern and role of impedance-pH variables in predicting PPI response in patients with suspected GERD-related chronic cough. Aliment Pharmacol Ther 2014;40:966–973. doi: 10.1111/apt.12919

^[12] Schepisi R, Fusco S, Sganga F et al. Inappropriate use of proton pump inhibitors in elderly patients discharged from acute care hospitals. J Nutr Health Aging 2016;20:665–670. doi: 10.1007/s12603-015-0642-5

^[13] Haastrup PF, Rasmussen S, Hansen JM et al. General practice variation when initiating long-term prescribing of proton pump inhibitors: a nationwide cohort study. BMC Fam Pract 2016;17:57. doi: 10.1186/s12875-016-0460-9

^[14] Haastrup PF, Paulsen MS, Christensen RD et al. Medical and non-medical predictors of initiating long-term use of proton pump inhibitors: a nationwide cohort study of first-time users during a 10-year period. Aliment Pharmacol Ther 2016;44:78–87. doi: 10.1111/apt.13649

^[15] van den Bemt PM, Chaaouit N, van Lieshout EM et al. Noncompliance with guidelines on proton pump inhibitor prescription as gastroprotection in hospitalized surgical patients who are prescribed NSAIDs. Eur J Gastroenterol Hepatol 2016. doi: 10.1097/MEG.0000000000000634

^[16] Batuwitage BT, Kingham JG, Morgan NE et al. Inappropriate prescribing of proton pump inhibitors in primary care. Postgrad Med J 2007;83:66–68. doi: 10.1136/pgmj.2006.051151

^[17] Jarchow-Macdonald AA & Mangoni AA. Prescribing patterns of proton pump inhibitors in older hospitalized patients in a Scottish health board. Geriatr Gerontol Int 2013;13:1002–1009. doi: 10.1111/ggi.12047

^[18] Van Soest EM, Siersema PD, Dieleman JP et al. Persistence and adherence to proton pump inhibitors in daily clinical practice. Aliment Pharmacol Ther 2006;24:377–385. doi: 10.1111/j.1365-2036.2006.02982.x