Editorial
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Feb 6, 2016; 7(1): 1-4
Published online Feb 6, 2016. doi: 10.4292/wjgpt.v7.i1.1
Proton pump inhibitor prescription abuse and sepsis in cirrhosis
Antonio Picardi, Umberto Vespasiani-Gentilucci
Antonio Picardi, Umberto Vespasiani-Gentilucci, Internal Medicine and Hepatology Unit, University Campus Bio-Medico, 00128 Rome, Italy
Author contributions: Picardi A wrote the manuscript; Vespasiani-Gentilucci U contributed a critical revision of the manuscript.
Conflict-of-interest statement: Both authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonio Picardi, MD, PhD, Internal Medicine and Hepatology Unit, University Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy. a.picardi@unicampus.it
Telephone: +39-6-225411207 Fax: +39-6-225411944
Received: May 27, 2015
Peer-review started: May 30, 2015
First decision: August 14, 2015
Revised: September 8, 2015
Accepted: November 3, 2015
Article in press: November 4, 2015
Published online: February 6, 2016
Abstract

Proton pump inhibitors (PPIs) represent one of the most extensively prescribed classes of drugs in general and in patients with liver cirrhosis. Many prescriptions are made without a clear adherence to standard indications. As a class of ordinarily well tolerated drug, PPIs are not free of side-effects and concerns have been raised about a possible role for PPIs in predisposing patients to an increased risk of bacterial infections and sepsis. As evidences of different power are accumulating on this topic, prospective studies are needed to reach a more universal agreement, but definitely more attention is needed by prescribers in being more adherent to the few recognized indications for the use of PPIs, particularly in patients with liver cirrhosis. Otherwise, doctors could run the risk of being accused of “abused” prescription.

Keywords: Proton pump inhibitors, Liver cirrhosis, Bacterial infection, Sepsis

Core tip: Many prescriptions of proton pump inhibitors (PPIs) are made without adhering to standard recognized indications. PPIs are ordinarily well tolerated but are not free of side-effects, and, in patients with liver cirrhosis, concerns are accruing on a possible role for PPIs in increasing the risk of infections and sepsis. As evidences of different power are accumulating, prospective studies are needed. However, prescribers should put definitely more attention in adhering to the recognized indications for the use of PPIs, especially in patients with cirrhosis. Otherwise, doctors could be responsible for “abuse” of prescription.