Increased Rate of Spontaneous Bacterial Peritonitis Among Cirrhotic Patients Receiving Pharmacologic Acid Suppression

Proton pump inhibitor use and risk of spontaneous bacterial peritonitis in cirrhotic patients: a systematic review and meta-analysis

“…However, conflicting results have been reported concerning the association between PPI use, intestinal permeability, and SIBO (Ratuapli et al, 2012;van Vlerken et al, 2012). One study that compared patients who had taken PPIs in the previous 7 days to patients who had taken PPIs in the previous 8 to 90 days found that only patients who had taken PPIs in the previous 7 days were at risk of developing SBP (Goel et al, 2012). Since SIBO rarely develops in a shorter period, other mechanisms may be implicated.…”

“…Twelve studies were published in journals (Campbell et al, 2008;Bajaj et al, 2009;Choi et al, 2011;Goel et al, 2012;van Vlerken et al, 2012;de Vos et al, 2013;Kwon et al, 2014;Merli et al, 2014;Min et al, 2014;Miura et al, 2014;O'Leary et al, 2014;Ratelle et al, 2014) and 5 studies were reported as conference abstracts (Northup et al, 2008;Bulsiewicz et al, 2009;Aditi et al, 2012;Terg et al, 2012;Mandorfer et al, 2014). We included 8 retrospective cohort studies, 6 case-control studies, and 3 prospective cohort studies.…”

“…For example, cirrhotic patients with dyspepsia caused by impaired intestinal motility may have pre-existing SIBO, predisposing them to SBP (Bajaj et al, 2009). Not all studies excluded patients who had received prior antibiotic treatment and patients with immunosuppressive conditions (Bajaj et al, 2009;Choi et al, 2011;Goel et al, 2012). It is also notable that the included studies did not adjust for the same confounders, and they generally failed to account for one or more of the following SBP risk factors: increased age, low fluid protein concentration, high MELD score or CPS, and increased international normalized ratio.…”

“…Notably, Choi et al (2011) compared patients who used PPIs for the median duration of time to PPI non-users, deducing that longer duration of PPI use may be associated with an increased risk of SBP. Goel et al (2012) found that patients who had taken PPIs 8 to 90 days before hospitalization for cirrhosis were 79% less likely to develop SBP than those who had taken PPIs within 7 days. Later, Kwon et al (2014) showed that both PPI use 8 to 30 days before hospitalization for cirrhosis as well as PPI use within 7 days before hospitalization significantly increased the risk of SBP (P = 0.009 and P = 0.001, respectively).…”

The burden of extended-spectrum β-lactamase-producing Enterobacteriaceae in patients with cirrhosis

“…We also attempt to perform swabs seeking for carriage of ESBL-producing strains in patients who are in frequent contact with the health care system and who fulfill the following criteria: on the waiting list, any admission for an acute decompensation of cirrhosis, refractory ascites treated by repeated largevolume paracentesis, use of long-term antibiotic prophylaxis. Since there are ten studies [22][23][24][25][26][27][28][29][30][31] and one metaanalysis [32] showing that the use of proton-pump inhibitors increases the risk of developing SBP, PPI administration should not be recommended, at least in patients with ascites.…”