Taking proton-pump inhibitors (PPIs) to treat heartburn and acid reflux may cause loss of brain function and a bacterial infection in people with cirrhosis of the liver.
Researchers in Denmark followed 895 patients with either cirrhosis or a condition known as ascites, which is fluid buildup in the abdomen. The original purpose of the study was to examine the effectiveness of a treatment for ascites. A total of 52% of the patients enrolled used a PPI at some point during the trial.
Those who had taken a PPI had a 31% 1-year cumulative risk for hepatic encephalopathy (HE), a loss of brain function when the liver has trouble excreting toxins out of the bloodstream, the researchers reported in the journal Hepatology. The risk for those who did not take a PPI was 25%.
“The findings that PPI use is a risk factor for [spontaneous bacterial peritonitis (SBP)] and that SBP is a risk factor for HE do provide support for the hypothesis that PPIs contribute to the development of HE by promoting translocation of gut bacteria,” the researchers wrote. SBP is a bacterial infection.
PPIs were developed to reduce the production of gastric acid in the gut, as well as increase the pH in the stomach. However, by doing so, they can also cause gut bacteria to multiply and enter the blood and lymph nodes. This can then lead to SBP and hepatic encephalopathy.
The researchers conclude that doctors should be cautious when prescribing PPIs to those with cirrhosis or possible cirrhosis.