PPIs use improves survival in cirrhosis patients with prior GI bleeding, study shows

USA: A recent study has found that the use of proton pump inhibitors (PPIs) for people with prior gastrointestinal bleeding (GIB) is associated with reduced mortality for veterans with cirrhosis. This indicates the benefit of PPIs in the presence of an appropriate indication. 

"PPI exposure in other patients however was associated with an increased risk of decompensation and infection in cirrhosis, which may mediate liver-related mortality," Nadim Mahmud, Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, and colleagues wrote in their study published in the journal Gastroenterology.

The impact of PPI medications on adverse outcomes in cirrhosis is controversial. Dr. Mahmud and the team, therefore, aimed to evaluate the association between PPI exposure and all-cause mortality, infection, and decompensation in a large national cohort. 

For this purpose, the researchers conducted a retrospective study of patients with cirrhosis in the Veterans Health Administration. PPI exposure was distinguished as a time-updating variable from the index time of cirrhosis diagnosis. They performed inverse probability treatment weighting-adjusted Cox regression with additional adjustment for key time-varying covariates including cardiovascular comorbidities, gastrointestinal bleeding (GIB), and statin exposure.