Author information
1
Dept. of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
2
Dept. of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
Abstract
BACKGROUND:
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.
AIM:
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.
RESULTS:
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.
CONCLUSION:
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.