Are proton pump inhibitors a threat for spontaneous bacterial peritonitis and hepatic encephalopathy in cirrhosis? Not so fast. (Ali Khan M. Hepatology 2016)

These trials were designed to address a separate issue and not to assess the effect of PPIs on the development of SBP or HE. Therefore, they cannot account for all potential confounders. In observational epidemiology, summary risk estimates of below 2 are more likely to indicate confounding than causality (Obstet Gynecol 2012;120:920-7)... Αί·« ... Dam et al found that only 56% of the patents in their retrospective analysis had a valid indication for PPI use. As with all drugs, PPIs should be used in their lowest effective dose and only for appropriate indications - in cirrhotic and non-cirrhotic patients alike. However, based on the evidence presented by Dam et al, it is premature to conclude that PPIs pose a major threat of SBP and HE in patients with cirrhosis. PPI treatment should not be withheld from cirrhotic patients who have a valid indication for it