title: Inadequate use of proton-pump inhibitors in patients with liver cirrhosis.
abstract: OBJECTIVE
  Patients with liver cirrhosis have a high prevalence of gastrointestinal symptoms. The use of antiacid therapy (AAT) in these patients is unexplored. We aimed to assess the use of AAT in cirrhotic patients.
  
  
  METHODS
  A total of 128 consecutive cirrhotic patients were evaluated for the use of and indications for acid-suppressive agents. Upper endoscopy findings and concomitant medications were registered. A validated questionnaire was used to measure the gastrointestinal symptom burden. Adequate indications for AAT were those strongly supported by the medical literature.
  
  
  RESULTS
  Forty percent (n=51) of patients with cirrhosis were on AAT. Thirty-seven percent (n=19) of these had adequate and 63% (n=32) inadequate indications for AAT. The major inadequate indication was previous variceal bleeding (34%). Patients with inadequate indications for AAT had increased severity of symptoms of indigestion compared with patients without AAT (P<0.05). Multivariate analysis revealed that inadequate use of AAT was independently related only to previous variceal bleeding and the number of concomitant medications.
  
  
  CONCLUSIONS
  AAT is used by a large proportion of patients with cirrhosis. In the majority, therapy is based on inadequate indications, mainly continuous long-term therapy after previous variceal bleeding. Patients with an inadequate indication for acid-suppressive medications have increased severity of symptoms of indigestion, indicating that gastrointestinal symptoms might be a factor contributing to proton-pump inhibitor consumption in these patients.
authors.affiliation: Section of Gastroenterology and Hepatology, Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. evangelos.kalaitzakis@vgregion.se
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kalaitzakis
authors.forename: Einar
authors.initials: E
authors.lastname: Björnsson
mesh_terms: D000328:Adult; D000368:Aged; D004415:Dyspepsia / Q000188:drug therapy / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy* / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors