title: PPIs are not associated with a lower incidence of portal-hypertension-related bleeding in cirrhosis.
abstract: OBJECTIVE
  To determine if proton pump inhibitor use in cirrhotic patients with endoscopic findings of portal hypertension is associated with a lower frequency of gastrointestinal bleeding.
  
  
  METHODS
  Patients with cirrhosis and endoscopic findings related to portal hypertension, receiving or not receiving proton pump inhibitor (PPI) therapy, were included retrospectively. We assigned patients to two groups: group 1 patients underwent PPI therapy and group 2 patients did not undergo PPI therapy.
  
  
  RESULTS
  One hundred and five patients with a median age of 58 (26-87) years were included, 57 (54.3%) of which were women. Esophageal varices were found in 82 (78%) patients, portal hypertensive gastropathy in 72 (68.6%) patients, and gastric varices in 15 (14.3%) patients. PPI therapy was used in 45.5% of patients (n = 48). Seventeen (16.1%) patients presented with upper gastrointestinal bleeding; in 14/17 (82.3%) patients, bleeding was secondary to esophageal varices, and in 3/17 patients bleeding was attributed to portal hypertensive gastropathy. Bleeding related to portal hypertension according to PPI therapy occurred in 18.7% (n = 9) of group 1 and in 14% (n = 8) of group 2 (odds ratio: 0.83, 95% confidence interval: 0.5-1.3, P = 0.51).
  
  
  CONCLUSIONS
  Portal hypertension bleeding is not associated with PPI use. These findings do not support the prescription of PPIs in patients with chronic liver disease with no currently accepted indication.
authors.affiliation: Endoscopy Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Vasco de Quiroga #15, Col. Sección XVI. Del. Tlalpan, C.P. 14000, Mexico City, México.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Garcia-Saenz-de-Sicilia
authors.forename: Francisco
authors.initials: F
authors.lastname: Sanchez-Avila
authors.forename: Norberto-C
authors.initials: NC
authors.lastname: Chavez-Tapia
authors.forename: Gustavo
authors.initials: G
authors.lastname: Lopez-Arce
authors.forename: Sandra
authors.initials: S
authors.lastname: Garcia-Osogobio
authors.forename: Roberto
authors.initials: R
authors.lastname: Ruiz-Cordero
authors.forename: Felix-I
authors.initials: FI
authors.lastname: Tellez-Avila
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008103:Liver Cirrhosis / Q000150:complications*; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D054328:Proton Pump Inhibitors