Lodato Francesca, Azzaroli Francesco, Di Girolamo Maria, Feletti Valentina, Cecinato Paolo, Lisotti Andrea, Festi Davide, Roda Enrico, Mazzella Giuseppe
Dipartimento di Medicina Interna e Gastroenterologia, U.O. di Gastroenterologia, Via Massarenti 9, Bologna 40138, Italy.
World J Gastroenterol. 2008 May 21;14(19):2980-5. doi: 10.3748/wjg.14.2980.
Proton pump inhibitors (PPI) are very effective in inhibiting acid secretion and are extensively used in many acid related diseases. They are also often used in patients with cirrhosis sometimes in the absence of a specific acid related disease, with the aim of preventing peptic complications in patients with variceal or hypertensive gastropathic bleeding receiving multidrug treatment. Contradicting reports support their use in cirrhosis and evidence of their efficacy in this condition is poor. Moreover there are convincing papers suggesting that acid secretion is reduced in patients with liver cirrhosis. With regard to Helicobacter pylori (H pylori) infection, its prevalence in patients with cirrhosis is largely variable among different studies, and it seems that H pylori eradication does not prevent gastro-duodenal ulcer formation and bleeding. With regard to the prevention and treatment of oesophageal complications after banding or sclerotherapy of oesophageal varices, there is little evidence for a protective role of PPI. Moreover, due to liver metabolism of PPI, the dose of most available PPIs should be reduced in cirrhotics. In conclusion, the use of this class of drugs seems more habit related than evidence-based eventually leading to an increase in health costs.
质子泵抑制剂（PPI）在抑制胃酸分泌方面非常有效，广泛应用于多种与酸相关的疾病。它们也常用于肝硬化患者，有时甚至在没有特定酸相关疾病的情况下使用，目的是预防接受多种药物治疗的静脉曲张或肥厚性胃病出血患者的消化性并发症。相互矛盾的报告支持它们在肝硬化中的使用，且在这种情况下其疗效证据不足。此外，有令人信服的论文表明肝硬化患者的胃酸分泌会减少。关于幽门螺杆菌（H pylori）感染，其在肝硬化患者中的患病率在不同研究中差异很大，而且根除幽门螺杆菌似乎并不能预防胃十二指肠溃疡的形成和出血。关于食管静脉曲张套扎或硬化治疗后食管并发症的预防和治疗，几乎没有证据表明PPI具有保护作用。此外，由于PPI经肝脏代谢，大多数现有PPI的剂量在肝硬化患者中应减少。总之，这类药物的使用似乎更多与习惯有关，而非基于证据，最终导致医疗成本增加。
