The Use of Proton Pump Inhibitors in Patients with Liver Cirrhosis: Real Life Experience

Abstract

(1) Background: Proton pump inhibitors (PPIs) are commonly prescribed for gastric disorders. In patients with liver cirrhosis, PPI use is associated with an increased risk of spontaneous bacterial peritonitis and increased mortality rates; therefore, they should be used with caution. This study aims to evaluate the appropriateness of PPI prescriptions in hospitalized cirrhotic patients against current clinical guidelines to identify patterns of misuse and guide better prescribing practices. (2) Methods: A retrospective study was conducted on liver cirrhosis inpatients in an internal medicine department from January 2022 to May 2023. The primary measure was the proportion of PPI prescriptions aligned with clinical guidelines. Medical files were entirely reviewed by researchers to assess the appropriateness of PPI prescriptions using the current guidelines. Outcomes included the identification of common reasons for PPI prescription and the rate of inappropriate PPI use among the study population. (3) Results: The study included 189 cirrhotic patients, with PPIs prescribed to 95 (50.2%) patients during hospitalization and 75 (39.7%) patients at discharge. Among those, 47.4% of the inpatients and 34.7% at discharge had no valid indication for PPI administration. The most common reason for PPI prescription during hospital stays was gastritis, followed by antiplatelet use in high-risk patients, ulcers, and upper gastrointestinal bleeding. The most common inappropriate indication was portal hypertensive gastropathy (PHG), followed by treatment with corticosteroids and anticoagulants alone. We did not find an association between PPI administration during hospital stays and infections. Only in 4% of cases patients should have received PPIs and did not. (4) Conclusions: There is a concerning overprescription of PPIs in cirrhotic patients, often deviating from established guidelines. It subjects patients to unnecessary risks. There is an urgent need for increased awareness and adherence to clinical guidelines regarding PPI prescriptions in cirrhotic patients.

Keywords: adverse drug reaction; drugs; hepatotoxicity; liver cirrhosis; liver injury; proton pump inhibitors.

Figure 1

Selection of patients with liver cirrhosis and PPI prescriptions during hospital stay and at discharge.

Figure 2

The prevalence of comorbidities reported in the cohort of cirrhotic patients (n = 189).

Figure 3

The number of patients with liver cirrhosis who were prescribed PPIs during hospitalization and at discharge.

Figure 4

Reasons for non-valid indication for PPI use. During hospital stays, 45 patients did not have a valid indication, and results are presented as absolute and relative frequency (out of 45 patients). At discharge, there were 26 patients without a valid indication for PPI use; results are presented as absolute and relative frequency (out of 26 patients).

Figure 5

Indications for PPI prescription during hospitalization. The relative frequencies are out of a total of 95 patients who received PPIs during hospital stays; PUD, peptic ulcer disease; UGIB, upper gastrointestinal bleeding; NSAID, non-steroid anti-inflammatory drugs; GERD, gastroesophageal reflux disease.

Figure 6

Indications for PPI prescription at discharge. The relative frequencies are out of a total of 75 patients who received PPIs at discharge. PUD, peptic ulcer disease; UGIB, upper gastrointestinal bleeding; NSAID, non-steroid anti-inflammatory drugs; GERD, gastroesophageal reflux disease.