Dept. of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
Dept. of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
Minimal hepatic encephalopathy (MHE) is a subclinical cognitive impairment frequently observable in cirrhotics. Proton pump inhibitors (PPIs) can contribute to small-bowel bacterial overgrowth but no study investigated the link between PPIs and MHE.
to investigate the relationship between minimal HE and PPIs use as well as the role of PPIs use in the development of overt HE and survival.
PATIENTS AND METHODS:
310 consecutive cirrhotic patients were included in the study and followed up for 14.1±12.3 months. At entry, MHE was diagnosed when the Psychometric Hepatic Encephalopathy Score (PHES) was ≤ -4. Data were analyzed by logistic regression for the factors associated to MHE and by time related models for overt HE development and survival.
at inclusion, 131 out of 310 cirrhotic patients (42%) were affected by MHE. One hundred and twenty-five patients (40%) were using PPIs. The variables independently associated to the presence of MHE were: PPIs use, previous overt HE, low albumin, low sodium and age. During follow-up, the development of overt HE was higher (64% vs 25%; p<0.001) and overall survival lower (41% vs 81%; p<0.001) in PPIs users than in non-users. Variables independently associated to the development of overt HE were: PPIs, history of overt HE, low albumin, MHE and age while variables independently associated to mortality were: PPIs, development of overt HE, MELD score, age, low sodium and age.
the study identifies a potentially removable factor associated to the presence of minimal HE and related to the development of overt HE and survival in patients with liver cirrhosis.