Proton pump inhibitor is a risk factor for recurrence of common bile duct stones after endoscopic sphincterotomy – propensity score matching analysis

Abstract

Background and study aims Recurrence of common bile duct stones (CBDS) in patients treated with endoscopic sphincterotomy (ES) can lead to deterioration in their quality of life. Although the pathology and related factors are unclear, we speculated that proton pump inhibiter (PPI) administration increases the risk of CBDS recurrence by altering the bacterial mixture in the bile duct. Patients and methods The primary endpoint of this retrospective study was recurrence-free period. Several independent variables considered to have a relationship with CBDS recurrence including PPI use were analyzed using a COX proportional hazard model, with potential risk factors then evaluated by propensity score matching analysis. Results A total of 219 patients were analyzed, with CBDS recurrence found in 44. Analysis of variables using a COX proportional hazard model demonstrated that use of PPIs and ursodeoxycholic acid (UDCA), as well as the presence of periampullary diverticula (PD) each had a hazard ratio (HR) value greater than 1 (HR 2.2, P = 0.007; HR 2.0, P = 0.02; HR 1.9, P = 0.07; respectively). Furthermore, propensity score matching analysis revealed that the mean recurrence-free period in the oral PPI cohort was significantly shorter as compared with the non-PPI cohort (1613 vs. 2587 days, P = 0.014). In contrast, neither UDCA administration nor PD presence was found to be a significant factor in that analysis (1557 vs. 1654 days, P = 0.508; 1169 vs. 2011 days, P = 0.121; respectively). Conclusion Our results showed that oral PPI administration is a risk factor for CBDS recurrence in patients who undergo ES.

A Six-Year Retrospective Follow-up of 502 Patients with Laparoscopic Cholelithotomy for Gallstone Recurrence: Success or Prospect

“…Our study is consistent with previous findings 23 that the incision location becomes a potential risk factor for recurrence of common bile duct stones. Therefore, a surgical incision located at the fundus reduces the pressure on the wall of the common bile duct.…”

Association Between Proton Pump Inhibitor Use and Biliary Tract Cancer Risk: A Swedish Population‐Based Cohort Study

“…Similarly, in a population-based case-control study conducted in Taiwan, 23% elevated risk of acute cholecystitis was found among PPI users compared to non-users (18). A retrospective cohort from Japan of 219 patients who underwent endoscopic sphincterotomy noted a 2.2-fold risk of recurrent common bile duct stones associated with PPI use (19). A recent hospital-based case-control analysis from China noted a 1.56-fold increased risk of gallbladder cancer, and the risk consistently increased with the duration of PPI use (20).…”

“…Of note, the majority of previous studies on biliary tract disorders association with PPI use, originates from regions with historical risk factors for biliary tract diseases as viral hepatitis and liver flukes (18)(19)(20)36). Other studies also showed that prolonged PPI use was associated with increased risk of gastric (47), pancreatic (16) and colorectal carcinoma from diverse populations as well (22,32,48).…”

“…( 18 ) A retrospective cohort from Japan of 219 patients who underwent endoscopic sphincterotomy noted a 2.2‐fold risk of recurrent common bile duct stones associated with PPI use. ( 19 ) A recent hospital‐based case‐control analysis from China noted a 1.56‐fold increased risk of gallbladder cancer, and the risk consistently increased with the duration of PPI use. ( 20 ) Conversely, in a prospective, randomized, placebo‐controlled trial of 17,598 persons followed for a median of 3 years, pantoprazole use was not associated with development of gastrointestinal cancers versus placebo.…”

Association Between Regular Use of Gastric Acid Suppressants and Subsequent Risk of Cholelithiasis: A Prospective Cohort Study of 0.47 Million Participants

“…In a large nationwide cohort study, Min et al reported that PPI use was associated with an increased risk of cholangitis (HR 5.75; 95% CI, 4.39-7.54) (Min et al, 2019). A propensity score matching analysis showed that PPI use was associated with significantly higher risk of recurrence of common bile duct stones in patients treated with endoscopic sphincterotomy (Fukuba et al, 2017). Additionally, in a hospital-based case-control study from China, PPI use was associated with an increased risk of gallbladder cancer, with higher risk observed in patients with longer duration of PPIs use (Xiong et al, 2020).…”