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Proton Pump Inhibitor Use Is Associated with an Increased Frequency of New or Worsening Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation.

Publication ,  Journal Article
Lewis, DS; Lee, T-H; Konanur, M; Ziegler, C; Hall, MD; Pabon-Ramos, WM; Suhocki, PV; Smith, TP; Kim, CY; Choi, SS; Ronald, J
Published in: J Vasc Interv Radiol
February 2019

PURPOSE: To determine whether proton pump inhibitor (PPI) use increases the rate of new or worsening hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS: In this retrospective study, 284 of 365 patients who underwent TIPS creation from January 1, 2005, to December 31, 2016, were analyzed (186 male, mean age 56 y, range 19-84 y). Dates of PPI use and dates of new or worsening HE, defined as hospitalization or escalation in outpatient medical management, were extracted from medical records. Mixed-effects negative binomial regression was used to test for an association between PPI usage and HE. RESULTS: After TIPS creation, among 168 patients on PPIs chronically, there were 235 episodes of new or worsening HE in 106,101 person-days (0.81/person-year). Among 55 patients never on PPIs, there were 37 episodes in 31,066 person-days (0.43/person-year). Among 61 patients intermittently taking PPIs, there were 78 episodes in 37,710 person-days while on PPIs (0.75/person-year) and 25 episodes in 35,678 person-days while off PPIs (0.26/person-year). In univariate regression, PPI usage was associated with a 3.34-fold increased rate of new or worsening HE (incidence rate ratio [IRR] 3.34; P < .001). In multivariate regression, older age (IRR 1.05; P < .001), male sex (IRR 1.58; P = .023), higher Model for End-Stage Liver Disease score (IRR 1.06; P = .015), previous HE or HE-preventive medication use (IRR 1.51; P = .029), and PPI use (IRR 3.19; P < .001) were significant risk factors. Higher PPI doses were associated with higher rates of HE (IRR 1.16 per 10 mg omeprazole equivalent; P = .046). CONCLUSIONS: PPI usage is associated with increased rates of new or worsening HE after TIPS creation.

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Published In

J Vasc Interv Radiol

DOI

EISSN

1535-7732

Publication Date

February 2019

Volume

30

Issue

2

Start / End Page

163 / 169

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Proton Pump Inhibitors
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
 

Citation

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Lewis, D. S., Lee, T.-H., Konanur, M., Ziegler, C., Hall, M. D., Pabon-Ramos, W. M., … Ronald, J. (2019). Proton Pump Inhibitor Use Is Associated with an Increased Frequency of New or Worsening Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation. J Vasc Interv Radiol, 30(2), 163–169. https://doi.org/10.1016/j.jvir.2018.10.015
Lewis, Douglas S., Tzu-Hao Lee, Meghana Konanur, Cole Ziegler, Melissa D. Hall, Waleska M. Pabon-Ramos, Paul V. Suhocki, et al. “Proton Pump Inhibitor Use Is Associated with an Increased Frequency of New or Worsening Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation.J Vasc Interv Radiol 30, no. 2 (February 2019): 163–69. https://doi.org/10.1016/j.jvir.2018.10.015.
Lewis DS, Lee T-H, Konanur M, Ziegler C, Hall MD, Pabon-Ramos WM, et al. Proton Pump Inhibitor Use Is Associated with an Increased Frequency of New or Worsening Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation. J Vasc Interv Radiol. 2019 Feb;30(2):163–9.
Lewis, Douglas S., et al. “Proton Pump Inhibitor Use Is Associated with an Increased Frequency of New or Worsening Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation.J Vasc Interv Radiol, vol. 30, no. 2, Feb. 2019, pp. 163–69. Pubmed, doi:10.1016/j.jvir.2018.10.015.
Lewis DS, Lee T-H, Konanur M, Ziegler C, Hall MD, Pabon-Ramos WM, Suhocki PV, Smith TP, Kim CY, Choi SS, Ronald J. Proton Pump Inhibitor Use Is Associated with an Increased Frequency of New or Worsening Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation. J Vasc Interv Radiol. 2019 Feb;30(2):163–169.
Journal cover image

Published In

J Vasc Interv Radiol

DOI

EISSN

1535-7732

Publication Date

February 2019

Volume

30

Issue

2

Start / End Page

163 / 169

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Proton Pump Inhibitors
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Nuclear Medicine & Medical Imaging
  • Middle Aged