Influence of proton pump inhibitors in the development of spontaneous bacterial peritonitis

Abstract

AIMTo investigate whether the use of proton pump inhibitors (PPIs) increases the incidence of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites.METHODSAn historical cohort study was carried out in cirrhotic outpatients with ascites followed in a specialized clinic at a tertiary hospital in Southern Brazil. Patient charts were reviewed to collect information on the variables of interest as the use of PPIs. Primary outcome was defined as development of SBP during the study period. SBP was diagnosed based on ascitic fluid polymorphonuclear cell count ≥ 250 cells/mm³ without evidence of an intra-abdominal, surgically treatable source of infection.RESULTSOf 738 cirrhotic patients, 582 (58.2% male) were enrolled, with mean age of 53.6 ± 12 years. Hepatitis C virus infection (36.2%) and alcohol abuse (25.6%) were the main etiologies of cirrhosis. The presence of ascites was detected in 299 (51.4%) patients during the development of the study. Nineteen patients with previous diagnosis of SBP undergoing secondary prophylaxis and 22 patients with insufficient PPI data were further excluded. Of 258 patients with ascites, 151 used PPIs, and 34 developed SBP (22.5%). Among 107 non-users of PPIs, 23 developed SBP (21.5%) (HR = 1.44, 95%CI: 0.85-2.47, P = 0.176). The median follow-up time of patients using PPI was 27 mo vs 32 mo for non-users. Univariate analysis of the risk factors associated with the development of SBP revealed a significant association of SPB with the severity of liver disease according to the Child-Turcotte-Pugh (CTP) score. Multivariate analysis confirmed that CTP score was the only independent variable influencing the occurrence of SBP. Survival at 60 mo (Kaplan-Meier analysis) was similar in users and non-users of PPI, independently of the presence of SBP (58.4% vs 62.7% respectively, P = 0.66). For patients with SBP, survival at 60 mo was 55.1%, vs 61.7% in patients without SBP (P = 0.34).CONCLUSIONIn conclusion, the rate of SBP was not significantly different in users or non-users of PPIs in this cohort of cirrhotic with ascites.

Increased Risk of Spontaneous Bacterial Peritonitis in Cirrhotic Patients Using Proton Pump Inhibitors

“…In a more recent retrospective cohort study that enrolled 307 cirrhotic patients with a previous SBP in Korea, the incidence of second SBP did not statistically differ between PPI users and non-PPI users who were followed up for 5 years [24]. Furthermore, a more recent cohort study conducted in southern Brazil that enrolled 258 cirrhotic patients with ascites did not confirm the high risk of SBP development in PPI users compared to PPI-non users [25].…”

How to Choose Between Percutaneous Transhepatic and Endoscopic Biliary Drainage in Malignant Obstructive Jaundice: An Updated Systematic Review and Meta-analysis

“…Moreover, in case of severe, difficult to handle obstructions, the drainage can only be partial, with subsequent bile stasis and higher risk of stasis-related secondary infections. Finally, the use of proton pump inhibitors (PPIs), some of the most frequently prescribed drugs worldwide, with subsequent hypochlorhydria, can influence duodenal bacterial flora and result in bacterial overgrowth in the duodenum (43)(44)(45); on this basis the use of EBD in patients receiving PPIs could be associated with an increased risk of phlogistic complications.…”

Acid suppression therapy and its association with spontaneous bacterial peritonitis incidence: A systemic review and meta‐analysis

“…We reviewed the remaining 33 articles with full-text thoroughly. Finally, 20 studies including 9566 cirrhotic patients [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] were identified according to our inclusion criteria. Meanwhile, there were six studies 18,19,[24][25][26]28 that also provided data about the association of H 2 RA and SBP.…”