Proton pump inhibitor therapy and its association with spontaneous bacterial peritonitis incidence and mortality: A meta-analysis

Letter: proton pump inhibitors and prognosis of cirrhosis – searching for the balance point

“…The most common cause of cirrhosis was hepatitis C (40%), followed by alcohol abuse (37%). PPIs use at baseline was reported In the present study, no association between PPIs and survival was observed, which is in agreement with Cole et al 1 The impact of PPIs on survival of patients with cirrhosis is controversial, 3,6,7 probably reflecting heterogeneity of included patients across the studies and other methodological issues, such as retrospective design and insufficient follow-up. In addition, detrimental effects of PPIs may be restricted to specific subgroups, such as patients with decompensated cirrhosis, especially in the presence of ascites.…”

Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use

“…This conclusion was mainly based on case-control studies in patients with liver cirrhosis and ascites. In 2016, Yu et al [28] reviewed 10 case-control and 6 cohort studies involving 8,145 patients, and showed that PPI use was associated with SBP (OR 2.11, 95% CI 1.46-3.06; Table 1). The association was limited in case-control studies (OR 2.97, 95% CI 2.06-4.26) but not in cohort studies (OR 1.18, 95% CI 0.99-1.14).…”

The Dark Side of the Long-Term Use of Proton Pump Inhibitors in Chronic Liver Disease

“…However, it should be noted that PPI users were older and suffered from more comorbidities (diabetes mellitus, hypertension, and chronic liver disease, although the later not significant), all potentially confounders known to be associated with an increased risk of infections [13]. Two recent meta-analyses, including mostly observational studies, have reached the same conclusions [14, 15]. PPIs were associated with an increased risk of overall bacterial infection (OR = 1.98, 95% CI 1.36–2.87) and SBP (OR = 2.11, 95% CI 1.46–3.06 and OR = 2.17, 95% CI 1.46–3.23).…”