Blood microbiome and proton pump inhibitor treatment. Proton pump inhibitor treatment aggravates bacterial translocation in patients with advanced liver cirrhosis and portal hypertension

Recent studies have linked proton pump inhibitor (PPI) treatment to increased complications of cirrhosis, especially hepatic encephalopathy (HE). However, the underlying pathophysiological mechanisms remain unclear. The present study investigated the hypothesis that PPI treatment promotes complications of cirrhosis by aggravating subclinical bacterial translocation (BT) in patients with advanced cirrhosis and portal hypertension. Blood samples from the portal vein were obtained during implantation of a transjugular intrahepatic portosystemic shunt (TIPS) in a total of 80 matched cirrhosis patients with PPI treatment (n = 57) and without PPI treatment (n = 23). BT was identified using amplicon sequencing of the 16S ribosomal-RNA gene (V1V2 region). Further, intestinal-fatty acid binding protein (I-FABP) was measured as biomarker of gut barrier function.