Effect of Proton Pump Inhibitors on Mortality in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis

Hung, Tsung–Hsing; Tseng, Chih‐Wei; Lee, Hsing–Feng; Tsai, Chen-Chi; Tsai, Chen–Chi

doi:10.5604/01.3001.0012.7193

Cited by 16 publications

(10 citation statements)

References 32 publications

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“…In contrast, the most recent could not establish causality that PPI use increases the incidence of SBE [187]. There have been far fewer studies concerning mortality risk due to PPI in SBE patients; two recent studies reported increased long-term mortality risk in PPI users [189,190], whereas other authors fail to find such an association [187,191]. Finally, one study examined whether PPI use increases the risk for recurrent SBP in cirrhotic patients and concluded that PPI is not a risk factor for recurrent SBP [192].…”

Section: Microbiological Consequences Of Removing Gastric Acidmentioning

confidence: 99%

The Phylogeny and Biological Function of Gastric Juice—Microbiological Consequences of Removing Gastric Acid

Martinsen

Fossmark

Waldum

2019

IJMS

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Gastric juice is a unique combination of hydrochloric acid (HCl), lipase, and pepsin. Acidic gastric juice is found in all vertebrates, and its main function is to inactivate microorganisms. The phylogenetic preservation of this energy-consuming and, at times, hazardous function (acid-related diseases) reflects its biological importance. Proton pump inhibitors (PPIs) are one of the most widely used drugs in the world. Due to the reduced prevalence of Helicobacter pylori infection as well as the increased use of inhibitors of gastric acid secretion, the latter has become the most important cause of gastric hypoacidity. In the present manuscript, we review the microbiological consequences of removing gastric acidity. The resulting susceptibility to infections has not been studied extensively, and focus has mainly been restricted to bacterial and parasitic agents only. The strongest evidence concerning the relationship between hypochlorhydria and predisposition to infections relates to bacterial infections affecting the gastrointestinal tract. However, several other clinical settings with increased susceptibility to infections due to inhibited gastric acidity are discussed. We also discuss the impact of hypochlorhydria on the gut microbiome.

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Section: Microbiological Consequences Of Removing Gastric Acidmentioning

confidence: 99%

The Phylogeny and Biological Function of Gastric Juice—Microbiological Consequences of Removing Gastric Acid

Martinsen

Fossmark

Waldum

2019

IJMS

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“…An early meta-analysis published in 2015 showed that PPI use was not associated with increased mortality in patients with cirrhosis [11]. However, only four cohort studies [14,16,17,19] were included in the present study, and many related cohort studies have been published since the previous meta-analysis [18,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. In addition, it remains unknown…”

Section: Introductionmentioning

confidence: 89%

“…Overall, 21 cohort studies with 20,899 patients and 7457 death events were included, of which 16 were retrospective cohort studies [16][17][18][19][22][23][24][25][26][27][28][29][30][31][32][33], while the other five were prospective cohort [14,15,20,21,34]. As for the ethnicity of the patients, 12 studies included Caucasian patients [15,16,18,[20][21][22]24,28,29,[32][33][34], 7 included Asians [17,19,23,25,26,30,31], and the remaining 2 included patients with mixed ethnicity [14,27]. Most of the studies included patients with hospitalized patients with cirrhosis without serious clinical complications [14][15][16][17][18]…”

Section: Study Characteristics and Quality Evaluationmentioning

confidence: 99%

“…As for the ethnicity of the patients, 12 studies included Caucasian patients [15,16,18,[20][21][22]24,28,29,[32][33][34], 7 included Asians [17,19,23,25,26,30,31], and the remaining 2 included patients with mixed ethnicity [14,27]. Most of the studies included patients with hospitalized patients with cirrhosis without serious clinical complications [14][15][16][17][18][20][21][22][23][24][28][29][30]32,34], while six studies included cirrhotic patients with SBP [19,26], HE [25], Clostridium difficile infection [27], pneumonia [31], and after transjugular intrahepatic portosystemic shunt [33], respectively. The mean ages of the patients varied from 53 to 63 years, and the proportions of male patients varied from 53% to 77%.…”

Section: Study Characteristics and Quality Evaluationmentioning

confidence: 99%

“…The mean ages of the patients varied from 53 to 63 years, and the proportions of male patients varied from 53% to 77%. PPI use was defined as concurrent use at the admission in 13 studies [14,[16][17][18]20,22,[25][26][27][28][29]31,34], and any use during follow up in eight studies [15,19,21,23,24,30,32,33]. The follow-up durations varied from within hospitalization to 60 months.…”

Section: Study Characteristics and Quality Evaluationmentioning

confidence: 99%

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Proton pump inhibitor use and mortality in patients with cirrhosis: a meta-analysis of cohort studies

Wu¹,

Zhang

Yu³

et al. 2020

Bioscience Reports

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Background: Proton pump inhibitor (PPI) is commonly used in patients with cirrhosis. However, some studies demonstrated that PPI use was associated with adverse outcome in patients with cirrhosis. We aimed to perform a meta-analysis of cohort studies to evaluate the association between PPI use and mortality in cirrhotic patients. Methods: Relevant studies were obtained via search of PubMed and Embase databases. A randomized-effect model was used to pool the results. Subgroup analyses were performed to evaluate the source of heterogeneity. Results: Overall, 21 cohort studies with 20,899 patients and 7457 death events were included. The pooled results with a randomized-effect model showed that PPI use was associated with significantly increased risk of mortality in patients with cirrhosis (adjusted relative risk [RR] = RR: 1.39, P<0.001) with considerable heterogeneity (I2=73%). Subgroup analyses showed that characteristics such as patient ethnicity, sample size, definition of PPI use, and complications of patients did not affect the association. However, the association between PPI use and mortality was independent of study characteristics including patient ethnicity, sample size, complications, definition of PPI use, and follow-up duration. However, the association between PPI use and mortality in cirrhotic patients was significant in retrospective studies (RR: 1.40, P<0.001), but not in prospective studies (RR: 1.34, P=0.33). Conclusions: PPI use may be associated with moderately increased mortality in cirrhotic patients. Although prospective cohort studies are needed to validate our findings, PPI should only prescribed to cirrhotic patients with indications for the treatment.

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The concerns of proton pump inhibitors usage in cirrhotic patients with ascites

2020

Adv in Digestive Medicine

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Effect of Proton Pump Inhibitors on Mortality in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis

Cited by 16 publications

References 32 publications

The Phylogeny and Biological Function of Gastric Juice—Microbiological Consequences of Removing Gastric Acid

The Phylogeny and Biological Function of Gastric Juice—Microbiological Consequences of Removing Gastric Acid

Proton pump inhibitor use and mortality in patients with cirrhosis: a meta-analysis of cohort studies

The concerns of proton pump inhibitors usage in cirrhotic patients with ascites

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