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

Abstract

Background:The association between bacterial infections and proton pump inhibitors (PPIs) has recently been studied with debatable results. Aim: The aim of this study was to investigate the relationship between PPIs and the development of spontaneous bacterial peritonitis (SBP) or other bacterial infections in cirrhotic patients. Materials and Methods: Consecutive cirrhotic patients hospitalized from 2007 through 2012 to Hamad General Hospital-, Doha, Qatar, were enrolled and classified as PPI users or non-users according to PPI consumption in the 90 days prior to hospitalization. Cirrhosis was clinically diagnosed by a combination of physical, biochemical, radiological, and endoscopic findings, or by liver biopsy. Results: A total of 333 patients were included in this study, of whom 171 (51.4%) used PPIs and 162 (48.6%) did not use PPIs. PPI users were significantly older in age (p = 0.001). There was no statistical difference between the 2 groups in sex distribution and etiology of cirrhosis (p > 0.05 for both parameters). PPI users had a significantly higher incidence of overall bacterial infection (38%) than non-PPI users (13.6%), p = 0.0001. Statistical significance is observed specifically for SBP and chest infection (p = 0.0006 and p = 0.01, respectively). In multivariate analysis, older age (> 60 years; OR = 1.246, 95% CI 1.021-08.486; p = 0.02), and PPI use (OR = 2.149, 95% CI 1.124-06.188; p = 0.01) were independent predicting factors for SBP and overall bacterial infection. Conclusion: The present study shows that PPI use, as well as older age (> 60 years), was an independent predicting factor for the development of overall infection and SBP in hospitalized cirrhotic patients. Unless it is indicated, PPI therapy should be avoided in this group of patients, particularly in those older than 60 years of age. Resumo Introdução: A associação entre infeções bacterianas e os Inibidores da bomba de protões (IBPs) tem vindo a ser estudada com resultados discutíveis. Objetivo: O objetivo deste estudo foi investigar a relação entre IBPs e o desenvolvimento de peritonite bacteriana espontânea (PBE) ou outras infeções bacterianas em doentes cirróticos. Material e Métodos: Doentes consecutivos com cirrose hospitalizados entre 2007 e 2012 no Hamad General HospitalQatar foram selecionados e classificados como utilizadores ou não utilizadores de IBPs de acordo com o seu consumo nos 90 dias prévios ao internamento. A cirrose foi clinicamente diagnosticada por uma combinação de achados no exame físico, no estudo bioquímico, radiológico e endoscópico; ou por biopsia hepática. Resultados: Um total de 333 doentes foi incluído neste estudo, 171 (51.4%) medicados com IBPs e 162 não (48.6%). Os utilizadores de IBPs eram significativamente mais velhos (p = 0.001). Não se observaram diferenças estatísticas entre os dois grupos no que se refere ao sexo ou etiologia da cirrose (p > 0.05 para os dois parâmetros). A incidência global de infeções bacterianas foi significativamente superior nos utilizadores de IBPs (38%) do ...

Use of proton pump inhibitors is associated with a higher risk of pneumonia in cirrhotic patients: a systematic review and meta-analysis

“…Therefore, 35 full-length articles were thoroughly reviewed, and 27 articles were further excluded as they did not report the outcome of interest. Finally, 3 cohort and 5 cross-sectional studies with a total of 40,295 participants met the eligibility criteria and were included in the metaanalysis [10][11][12][13][14][15][16][17]. Two of the 3 included cohort studies were published as conference abstracts [10,14].…”

“…The use of PPI may also lead to an increased risk of other types of organspecific bacterial infection. In fact, studies have suggested an increased risk of bacterial pneumonia among cirrhotic patients who use PPIs, although the results are inconsistent [10][11][12][13][14][15][16][17]. The current study aimed to further investigate this risk by identifying all available studies and summarizing their results together.…”

The bacterial spectrum of spontaneous bacterial peritonitis in patients with cirrhosis of liver.

“…3,12 While a Study from Poland reported median Total Leukocye Count 571/mm 3 , medin Neutrophil Count 145/mm 3 and median total protein 1.85g/L. 15…”

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.…”