Brief Article
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World J Gastroenterol. Dec 14, 2010; 16(46): 5869-5873
Published online Dec 14, 2010. doi: 10.3748/wjg.v16.i46.5869
PPIs are not associated with a lower incidence of portal-hypertension-related bleeding in cirrhosis
Mauricio Garcia-Saenz-de-Sicilia, Francisco Sanchez-Avila, Norberto C Chavez-Tapia, Gustavo Lopez-Arce, Sandra Garcia-Osogobio, Roberto Ruiz-Cordero, Felix I Tellez-Avila
Mauricio Garcia-Saenz-de-Sicilia, Francisco Sanchez-Avila, Roberto Ruiz-Cordero, Department of Gastroenterology, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubiran, Mexico City, Mexico
Gustavo Lopez-Arce, Felix I Tellez-Avila, Endoscopy Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, 14000, Mexico
Norberto C Chavez-Tapia, Sandra Garcia-Osogobio, Medica Sur Clinic and Fundation, Mexico City, México
Author contributions: Garcia-Saenz-de-Sicilia M collected all the data and wrote the manuscript; Tellez-Avila FI and Chavez-Tapia NC designed the study, performed the statistical analysis and were involved in the final edition of the manuscript; Garcia-Osogobio S was involved in editing the manuscript; Chavez-Tapia NC, Lopez-Arce G, Sanchez-Avila F, Garcia-Osogobio S and Ruiz-Cordero R participated in the data collection and manuscript writing, including drafting the article and the final revision.
Correspondence to: Felix I Tellez-Avila, MD, 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.
Telephone: +52-55-54870900 Fax: +52-55-56553203
Received: August 4, 2010
Revised: September 2, 2010
Accepted: September 9, 2010
Published online: December 14, 2010

AIM: 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).

CONCLUSION: 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.

Keywords: Drug prescription, Liver cirrhosis, Portal hypertension, Proton pump inhibitors, Upper gastrointestinal bleeding