Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shebin El-Kom, Menoufia, Egypt.
Curr Gastroenterol Rep. 2024 Dec;26(12):323-334. doi: 10.1007/s11894-024-00943-7. Epub 2024 Aug 21.
This review explores the pharmacokinetics, benefits, and risks of proton pump inhibitors (PPIs) in cirrhotic patients, focusing on the appropriateness of their use and potential adverse effects.
Recent studies highlight significant pharmacokinetic alterations in PPIs among cirrhotic patients, with marked increases in lansoprazole and pantoprazole exposure and relatively stable levels of esomeprazole. While effective for managing acid-related disorders and post-band ulcer rebleeding, evidence supporting PPI use for portal hypertension-related bleeding is lacking. Emerging research suggests potential adverse effects such as hepatic decompensation, spontaneous bacterial peritonitis, hepatic encephalopathy, and increased mortality, possibly linked to dysbiosis and bacterial translocation. PPI use in cirrhotic patients alters pharmacokinetics significantly, with esomeprazole potentially safer in advanced cirrhosis. The review advises caution in routine PPI use beyond acid-related conditions due to limited evidence and substantial risks. It underscores the need for careful risk-benefit assessments and exploration of alternative therapies. Future research should aim to identify safer management strategies for portal hypertension complications and to develop evidence-based guidelines for PPI use in patients with cirrhosis.
本综述探讨了质子泵抑制剂（PPIs）在肝硬化患者中的药代动力学、益处和风险，重点关注其使用的适当性和潜在的不良反应。
最近的研究强调了肝硬化患者中 PPIs 的药代动力学显著改变，兰索拉唑和泮托拉唑的暴露显著增加，而埃索美拉唑的水平相对稳定。虽然 PPI 对于治疗酸相关疾病和套扎后溃疡再出血有效，但缺乏支持其用于门静脉高压相关出血的证据。新出现的研究表明，可能与菌群失调和细菌易位有关的潜在不良反应，如肝失代偿、自发性细菌性腹膜炎、肝性脑病和死亡率增加。肝硬化患者中 PPI 的使用会显著改变药代动力学，埃索美拉唑在晚期肝硬化中可能更安全。该综述建议在常规使用 PPI 治疗胃酸相关疾病以外的疾病时要谨慎，因为证据有限且风险较大。它强调了需要进行仔细的风险效益评估，并探索替代治疗方法。未来的研究应旨在确定更安全的门静脉高压并发症管理策略，并制定基于证据的肝硬化患者使用 PPI 的指南。
