Dose‐dependent impact of proton pump inhibitors on the clinical course of spontaneous bacterial peritonitis

Tergast, Tammo L.; Wranke, A.; Laser, H.; Gerbel, Svetlana; Manns, Michael P.; Cornberg, Markus; Maasoumy, Benjamin

doi:10.1111/liv.13862

Cited by 39 publications

(41 citation statements)

References 30 publications

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“…Patients were recruited from the Hannover ascites cohort (HAC) . The in‐ and exclusion criteria have been described previously . Briefly, all 1011 consecutive, hospitalised patients that underwent paracentesis at the Hannover Medical School between January 2012 and June 2016 were considered.…”

Section: Methodsmentioning

confidence: 99%

Systemic arterial blood pressure determines the therapeutic window of non‐selective beta blockers in decompensated cirrhosis

Tergast

Kimmann

Laser

et al. 2019

Aliment Pharmacol Ther

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Summary Background The safety of non‐selective β‐blockers in patients with advanced cirrhosis has been questioned in recent years. It was hypothesised that there is a particular therapeutic window. However, the specific limits still need to be determined. Aim To evaluate potential limits of the therapeutic window of non‐selective β‐blocker therapy in patients with cirrhosis and ascites Methods The impact of non‐selective β‐blockers on 28‐day transplant‐free survival was analysed in a cohort of 624 consecutive patients with decompensated cirrhosis and ascites. Three potential limits were investigated: spontaneous bacterial peritonitis, acute‐on‐chronic liver failure, mean arterial blood pressure ≤ 82 and < 65 mm Hg. Results Treatment with non‐selective β‐blockers was associated with a higher 28‐day transplant‐free survival in the overall cohort (hazard ratio: 0.621; P = .035) as well as in patients with acute‐on‐chronic liver failure (hazard ratio: 0.578; P = .031) and those with spontaneous bacterial peritonitis (hazard ratio: 0.594; P = .073). In contrast, survival benefits were markedly attenuated in patients with a mean arterial blood pressure ≤ 82 mm Hg and completely lost in those with mean arterial blood pressure < 65 mm Hg (P = .536). In spontaneous bacterial peritonitis patients with a mean arterial blood pressure < 65 mm Hg non‐selective β‐blocker treatment was associated with renal impairment. Of note, among those with a mean arterial blood pressure ≥ 65 mm Hg non‐selective β‐blocker intake was consistently associated with superior transplant‐free survival (hazard ratio: 0.582; P = .029) irrespective of the presence of spontaneous bacterial peritonitis (hazard ratio: 0.435; P = .028) or acute‐on‐chronic liver failure (hazard ratio: 0.480 P = .034). Conclusions Ascites, acute‐on‐chronic liver failure and spontaneous bacterial peritonitis do not limit the safe use of non‐selective β‐blockers in patients with cirrhosis. Mean arterial blood pressure might represent a better indicator to determine the therapeutic window of non‐selective β‐blocker treatment.

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Section: Methodsmentioning

confidence: 99%

Systemic arterial blood pressure determines the therapeutic window of non‐selective beta blockers in decompensated cirrhosis

Tergast

Kimmann

Laser

et al. 2019

Aliment Pharmacol Ther

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“…But evidence has revealed that PPIs influence the gut microbiota and potentially increase the risk for enteric infections, notably by increasing the risk for Clostridium difficile infection, which could lead to bacterial translocation . Use of PPIs predisposes to the development of complications associated with decompensated cirrhosis . However, little is known about the impact of PPIs on intestinal permeability in patients with cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

Proton pump inhibitor therapy does not increase serum endotoxin activity in patients with cirrhosis

Okada

Namisaki

Sato

et al. 2018

Hepatology Research

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“…Proper attention has not been paid to the prevention and treatment of cirrhotic patients with peptic ulcer in current practice. One reason was that the application of proton pump inhibitors (PPI) in liver cirrhosis was still on doubt [23][24][25][26], and the other reason was that the antibiotics for eradicating H. pylori may aggravate liver injury, especially for decompensated liver cirrhosis patients. Some studies proved that PPI did not increase the incidence of SBP [27], while other studies verified that PPI can induce SBP [28].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of peptic ulcer bleeding in cirrhosis with esophageal and gastric varices

Li¹,

Sun²,

Han³

et al. 2019

Preprint

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Dose‐dependent impact of proton pump inhibitors on the clinical course of spontaneous bacterial peritonitis

Abstract: High dosages of proton pump inhibitors are associated with an adverse outcome in patients with spontaneous bacterial peritonitis. Thus, indication for high-dosage proton pump inhibitors therapy should be evaluated carefully in these patients.

Cited by 39 publications

References 30 publications

Systemic arterial blood pressure determines the therapeutic window of non‐selective beta blockers in decompensated cirrhosis

Systemic arterial blood pressure determines the therapeutic window of non‐selective beta blockers in decompensated cirrhosis

Proton pump inhibitor therapy does not increase serum endotoxin activity in patients with cirrhosis

Characteristics of peptic ulcer bleeding in cirrhosis with esophageal and gastric varices

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