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Proton pump inhibitor use is associated with increased rates of post-TIPS hepatic encephalopathy: Replication in an independent patient cohort.

Publication ,  Journal Article
Dai, R; Sag, AA; Martin, JG; Befera, NT; Pabon-Ramos, WM; Suhocki, PV; Smith, TP; Kim, CY; Muir, AJ; Ronald, J
Published in: Clin Imaging
September 2021

PURPOSE: Proton pump inhibitor (PPI) use is a potential risk factor for hepatic encephalopathy (HE), but few studies have examined the effect on post-TIPS HE. The purpose of this study was to determine whether PPIs are associated with increased rates of post-TIPS HE in an independent patient cohort. MATERIALS AND METHODS: This single-institution retrospective study analyzed 86 patients (54 male, mean age 58.2) following TIPS from 1/1/2017 to 12/31/2019. Dates of PPI usage and episodes of new or worsening HE were recorded. Poisson regression with generalized estimating equations was used to test for association between PPI use and post-TIPS HE and to test for dose dependence. Post-TIPS HE was also analyzed using the Andersen-Gill survival model for recurrent events. RESULTS: There were 1.88 episodes of new or worsening post-TIPS HE per person-year among 35 patients on uninterrupted PPIs therapy, 1.95 on PPIs and 0.94 off PPIs among 35 patients on intermittent therapy, and 0.47 among 16 patients never on PPIs. PPI use was significantly associated with post-TIPS HE in both univariable (incidence rate ratio (IRR) = 2.62; CI = 1.41-4.84; p = 0.002) and multivariable (IRR = 2.31; CI = 1.37-3.89; p = 0.002) regression. Analysis of only those patients on PPIs showed increased rates of HE with higher doses (IRR = 1.17 per 10 mg omeprazole equivalent; CI = 1.04-1.33; p = 0.011). Recurrent events survival analysis supported the association between PPI use and HE in univariable (hazard ratio (HR) = 2.17; CI = 1.19-3.95; p = 0.011) and multivariable (HR = 1.87; CI = 1.12-3.13; p = 0.017) analysis. CONCLUSION: In an independent patient cohort PPI use was associated with increased rates of new or worsening post-TIPS HE.

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Published In

Clin Imaging

DOI

EISSN

1873-4499

Publication Date

September 2021

Volume

77

Start / End Page

187 / 192

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Proton Pump Inhibitors
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Liver Cirrhosis
  • Humans
  • Hepatic Encephalopathy
 

Citation

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Dai, R., Sag, A. A., Martin, J. G., Befera, N. T., Pabon-Ramos, W. M., Suhocki, P. V., … Ronald, J. (2021). Proton pump inhibitor use is associated with increased rates of post-TIPS hepatic encephalopathy: Replication in an independent patient cohort. Clin Imaging, 77, 187–192. https://doi.org/10.1016/j.clinimag.2021.04.034
Dai, Rui, Alan A. Sag, Jonathan G. Martin, Nicholas T. Befera, Waleska M. Pabon-Ramos, Paul V. Suhocki, Tony P. Smith, Charles Y. Kim, Andrew J. Muir, and James Ronald. “Proton pump inhibitor use is associated with increased rates of post-TIPS hepatic encephalopathy: Replication in an independent patient cohort.Clin Imaging 77 (September 2021): 187–92. https://doi.org/10.1016/j.clinimag.2021.04.034.
Dai R, Sag AA, Martin JG, Befera NT, Pabon-Ramos WM, Suhocki PV, et al. Proton pump inhibitor use is associated with increased rates of post-TIPS hepatic encephalopathy: Replication in an independent patient cohort. Clin Imaging. 2021 Sep;77:187–92.
Dai, Rui, et al. “Proton pump inhibitor use is associated with increased rates of post-TIPS hepatic encephalopathy: Replication in an independent patient cohort.Clin Imaging, vol. 77, Sept. 2021, pp. 187–92. Pubmed, doi:10.1016/j.clinimag.2021.04.034.
Dai R, Sag AA, Martin JG, Befera NT, Pabon-Ramos WM, Suhocki PV, Smith TP, Kim CY, Muir AJ, Ronald J. Proton pump inhibitor use is associated with increased rates of post-TIPS hepatic encephalopathy: Replication in an independent patient cohort. Clin Imaging. 2021 Sep;77:187–192.
Journal cover image

Published In

Clin Imaging

DOI

EISSN

1873-4499

Publication Date

September 2021

Volume

77

Start / End Page

187 / 192

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Proton Pump Inhibitors
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Liver Cirrhosis
  • Humans
  • Hepatic Encephalopathy