Do not prescribe proton pump inhibitors to patients with liver cirrhosis, outside of established indications

Type of practice


Topic Area


In patients with chronic liver disease and portal hypertension, even though acid secretion is markedly reduced, PPI therapy is often used even in the absence of an acid-related disease, in order to prevent bleeding from hypertensive gastropathy. This approach is not evidence-based and therefore not justified. In acute variceal bleeding, PPIs should be stopped immediately after the procedure unless there is a strict indication to continue them. In cirrhotic patients PPI use could be associated with an increased risk of complications, including spontaneous bacterial peritonitis, hepatic encephalopathy, mortality, and infections (gastroenteritis, lower respiratory and urinary tract infections).


1. Scarpignato C, Gatta L, Zullo A, et al. Italian Society of Pharmacology, the Italian Association of Hospital Gastroenterologists, and the Italian Federation of General Practitioners. Effective and safe proton pump inhibitor therapy in acid-related diseases - A position paper addressing benefits and potential harms of acid suppression. BMC Med 2016;14:179 .
2. De Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII - Renewing consensus in portal hypertension. J Hepatol 2022;76:959-974
3. Wang J, Wu Y, Bi Q, et al. Adverse outcomes of proton pump inhibitors in chronic liver disease: a systematic review and meta-analysis. Hepatol Int 2020;14:385-398
4. Labenz C, Kostev K, Galle PR, et al. Proton pump inhibitor use is associated with a variety of infections in patients with liver cirrhosis. Medicine 2020;99:e23436



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