Proton Pump Inhibitor Use before Percutaneous Endoscopic Gastrostomy Is Associated with Adverse Outcomes

Abstract

Background/AimsKnowledge of the risk factors associated with adverse outcomes after percutaneous endoscopic gastrostomy (PEG) may be helpful for developing PEG recommendations. The purpose of this study was to identify the clinical risk factors associated with adverse clinical outcomes after PEG, especially regarding the use of proton pump inhibitors (PPIs).MethodsWe retrospectively reviewed the data from PEG patients at seven university hospitals between June 2006 and January 2012. All patients were followed up through February 2012 after PEG, and the clinical risk factors for adverse clinical outcomes after PEG were analyzed.ResultsData from 1,021 PEG patients were analyzed. PPI users were more frequently included in the complication group than the noncomplication group (p=0.040). PEG-related complications (p=0.040) and mortality (p=0.003) were more frequent in the PPI group than in the control group. In the subgroup analysis of complicated PEG cases, infectious complications were more frequently found in the PPI group than in the control group (35.8% vs 27.8%). After adjustment for multiple possible confounding factors, PPI users (odds ratio, 1.531; 95% confidence interval, 1.017 to 2.305) and diabetic patients had increased mortality after PEG.ConclusionsPPI use may be associated with adverse outcomes in patients with PEG; however, further prospective studies investigating this issue are warranted.

Proton-pump inhibitors elevate infection rate in cardiothoracic surgery patients by influencing PMN function in vitro and in vivo

“…PPI + patients developed significantly more infections compared to PPI − patients, resulting in an OR of 1.86 (Table ). These results are consistent with observations in men and rodents . Studies by Im et al.…”

“…Studies by Im et al. indicated an elevated rate of infections and complications after percutaneous endoscopic gastrostomy due to PPI administration . Moreover, two case reports showed two severe postoperative infections after omeprazole medication before gastric resection .…”

“…19 Studies by Im et al indicated an elevated rate of infections and complications after percutaneous endoscopic gastrostomy due to PPI administration. 2 Moreover, two case reports showed two severe postoperative infections after omeprazole medication before gastric resection. 3 Furthermore, higher rate of sepsis and abscess formation was found in natural orifice transluminal endoscopic surgery in rat model.…”

“…Nevertheless, a PPI‐related increased risk of infections is discussed. There is clinical evidence of increased rates of community‐acquired pneumonia, C lostridium difficile infections or spontaneous bacterial peritonitis after PPI administration . Studies found a higher rate of nosocomial pneumonia in a population of cardiothoracic surgery patients using PPI instead of histamine H2 receptor antagonists (H2RA) as a prophylaxis of stress ulcers .…”

“…There is clinical evidence of increased rates of community-acquired pneumonia, Clostridium difficile infections or spontaneous bacterial peritonitis after PPI administration. [2][3][4][5] Studies found a higher rate of nosocomial pneumonia in a population of cardiothoracic surgery patients using PPI instead of histamine H2 receptor antagonists (H2RA) as a prophylaxis of stress ulcers. 6 Cardiac surgery is accompanied by developing systemic inflammatory response syndrome (SIRS) afterwards resulting in a higher risk for infections.…”