PMID- 30638914
OWN - NLM
STAT- MEDLINE
DCOM- 20190506
LR  - 20190506
IS  - 1535-7732 (Electronic)
IS  - 1051-0443 (Linking)
VI  - 30
IP  - 2
DP  - 2019 Feb
TI  - Proton Pump Inhibitor Use Is Associated with an Increased Frequency of New or 
      Worsening Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic 
      Shunt Creation.
PG  - 163-169
LID - S1051-0443(18)31602-6 [pii]
LID - 10.1016/j.jvir.2018.10.015 [doi]
AB  - 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.
CI  - Published by Elsevier Inc.
FAU - Lewis, Douglas S
AU  - Lewis DS
AD  - Division of Vascular and Interventional Radiology, Department of Radiology, Duke 
      University Medical Center, 2301 Erwin Road, Durham, North Carolina 27710.
FAU - Lee, Tzu-Hao
AU  - Lee TH
AD  - Division of Gastroenterology, Department of Medicine, Duke University Medical 
      Center, 2301 Erwin Road, Durham, North Carolina 27710.
FAU - Konanur, Meghana
AU  - Konanur M
AD  - Division of Vascular and Interventional Radiology, Department of Radiology, Duke 
      University Medical Center, 2301 Erwin Road, Durham, North Carolina 27710.
FAU - Ziegler, Cole
AU  - Ziegler C
AD  - Division of Vascular and Interventional Radiology, Department of Radiology, Duke 
      University Medical Center, 2301 Erwin Road, Durham, North Carolina 27710.
FAU - Hall, Melissa D
AU  - Hall MD
AD  - Division of Vascular and Interventional Radiology, Department of Radiology, Duke 
      University Medical Center, 2301 Erwin Road, Durham, North Carolina 27710.
FAU - Pabon-Ramos, Waleska M
AU  - Pabon-Ramos WM
AD  - Division of Vascular and Interventional Radiology, Department of Radiology, Duke 
      University Medical Center, 2301 Erwin Road, Durham, North Carolina 27710.
FAU - Suhocki, Paul V
AU  - Suhocki PV
AD  - Division of Vascular and Interventional Radiology, Department of Radiology, Duke 
      University Medical Center, 2301 Erwin Road, Durham, North Carolina 27710.
FAU - Smith, Tony P
AU  - Smith TP
AD  - Division of Vascular and Interventional Radiology, Department of Radiology, Duke 
      University Medical Center, 2301 Erwin Road, Durham, North Carolina 27710.
FAU - Kim, Charles Y
AU  - Kim CY
AD  - Division of Vascular and Interventional Radiology, Department of Radiology, Duke 
      University Medical Center, 2301 Erwin Road, Durham, North Carolina 27710.
FAU - Choi, Steven S
AU  - Choi SS
AD  - Division of Gastroenterology, Department of Medicine, Duke University Medical 
      Center, 2301 Erwin Road, Durham, North Carolina 27710.
FAU - Ronald, James
AU  - Ronald J
AD  - Division of Vascular and Interventional Radiology, Department of Radiology, Duke 
      University Medical Center, 2301 Erwin Road, Durham, North Carolina 27710. 
      Electronic address: james.ronald@duke.edu.
LA  - eng
PT  - Journal Article
DEP - 20190111
PL  - United States
TA  - J Vasc Interv Radiol
JT  - Journal of vascular and interventional radiology : JVIR
JID - 9203369
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Hepatic Encephalopathy/*chemically induced/diagnosis
MH  - Humans
MH  - Liver Cirrhosis/complications/diagnosis/*surgery
MH  - Male
MH  - Middle Aged
MH  - Portasystemic Shunt, Transjugular Intrahepatic/*adverse effects
MH  - Proton Pump Inhibitors/*adverse effects
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2019/01/15 06:00
MHDA- 2019/05/07 06:00
CRDT- 2019/01/15 06:00
PHST- 2018/08/14 00:00 [received]
PHST- 2018/10/10 00:00 [revised]
PHST- 2018/10/13 00:00 [accepted]
PHST- 2019/01/15 06:00 [pubmed]
PHST- 2019/05/07 06:00 [medline]
PHST- 2019/01/15 06:00 [entrez]
AID - S1051-0443(18)31602-6 [pii]
AID - 10.1016/j.jvir.2018.10.015 [doi]
PST - ppublish
SO  - J Vasc Interv Radiol. 2019 Feb;30(2):163-169. doi: 10.1016/j.jvir.2018.10.015. 
      Epub 2019 Jan 11.