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29 August 2008

Use and overuse of proton pump inhibitors in cirrhotic patients

Norberto C. Chavez-TapiaBCDEF, Felix I. Tellez-AvilaBCDEF, Jorge Garcia-LeivaEF, Miguel Angel ValdovinosACDE

Med Sci Monit 2008; 14(9): CR468-472 :: ID: 867964

Abstract

Background
There are several indications for the use of proton pump inhibitors (PPIs) but little evidence to support their use in patients with chronic liver disease. Moreover, the pattern of clinical use is unknown. The aim of the present study was to analyze the use of PPIs in patients with chronic liver disease in an ambulatory setting.
Material and Method
This was a retrospective study in a clinical setting. Clinical variables, severity indexes, and endoscopic findings were assessed. Management of PPIs was classified according to proven indication as: G1, proven indication and a prescription; G2, no proven indication and prescription; G3, proven indication and no prescription; and G4, no proven indication and no prescription. G1+G4 were considered proper use of PPIs. The classification was used to identify variables associated with proper use.
Results
The study included 243 patients (mean age: 55.82+/-12.9 years). The most common etiologies of chronic liver disease were hepatitis C virus infection and chronic alcoholic liver disease. PPIs were indicated in 46.1% patients. Multivariate analysis showed that a MELD score < or =8 points (OR: 2.6, 95% CI: 1.3-5.3), esophageal varices (OR: 0.38, 95% CI: 0.16-0.90), and previous in-hospital use of PPIs (OR: 0.78, 95% CI: 0.6-0.9) were associated with G1+G4.
Conclusions
Clinical use of PPIs in chronic liver disease was inappropriate in nearly one half of all patients. A less severe disease was associated with proper use and previous in-hospital use was associated with inappropriate use. Future research into the clinical use of PPIs in cirrhotic patients is mandatory.

Keywords: Proton Pump Inhibitors - therapeutic use, Liver Cirrhosis - physiopathology, Drug Utilization Review, Child, Blood Chemical Analysis, Analysis of Variance

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750