Influence of Proton Pump Inhibitors in the Development of Spontaneous Bacterial Peritonitis

Overview

Journal World J Hepatol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2018 Jan 2

PMID 29290909

Citations 11

Authors

Suelen A S Miozzo

Jorge A John

Marcelo C Appel-da-Silva

Isabella A Dossin

Cristiane V Tovo

Angelo A Mattos

Affiliations

Soon will be listed here.

Abstract

Aim: To investigate whether the use of proton pump inhibitors (PPIs) increases the incidence of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites.

Methods: An historical cohort study was carried out in cirrhotic outpatients with ascites followed in a specialized clinic at a tertiary hospital in Southern Brazil. Patient charts were reviewed to collect information on the variables of interest as the use of PPIs. Primary outcome was defined as development of SBP during the study period. SBP was diagnosed based on ascitic fluid polymorphonuclear cell count ≥ 250 cells/mm³ without evidence of an intra-abdominal, surgically treatable source of infection.

Results: Of 738 cirrhotic patients, 582 (58.2% male) were enrolled, with mean age of 53.6 ± 12 years. Hepatitis C virus infection (36.2%) and alcohol abuse (25.6%) were the main etiologies of cirrhosis. The presence of ascites was detected in 299 (51.4%) patients during the development of the study. Nineteen patients with previous diagnosis of SBP undergoing secondary prophylaxis and 22 patients with insufficient PPI data were further excluded. Of 258 patients with ascites, 151 used PPIs, and 34 developed SBP (22.5%). Among 107 non-users of PPIs, 23 developed SBP (21.5%) (HR = 1.44, 95%CI: 0.85-2.47, = 0.176). The median follow-up time of patients using PPI was 27 mo 32 mo for non-users. Univariate analysis of the risk factors associated with the development of SBP revealed a significant association of SPB with the severity of liver disease according to the Child-Turcotte-Pugh (CTP) score. Multivariate analysis confirmed that CTP score was the only independent variable influencing the occurrence of SBP. Survival at 60 mo (Kaplan-Meier analysis) was similar in users and non-users of PPI, independently of the presence of SBP (58.4% 62.7% respectively, = 0.66). For patients with SBP, survival at 60 mo was 55.1%, 61.7% in patients without SBP ( = 0.34).

Conclusion: In conclusion, the rate of SBP was not significantly different in users or non-users of PPIs in this cohort of cirrhotic with ascites.

Citing Articles

Proton Pump Inhibitors Increases Longitudinal Risk of Mortality, Decompensation, and Infection in Cirrhosis: A Meta-Analysis.

Wong Z, Koh J, Muthiah M, Koh B, Ong E, Ong C Dig Dis Sci. 2023; 69(1):289-297.

PMID: 37968557 DOI: 10.1007/s10620-023-08150-6.

Cirrhotic patients on proton pump inhibitors are at a twofold risk of spontaneous bacterial peritonitis independently of gastrointestinal bleeding: a population-based retrospective study.

Boustany A, Rahhal R, Onwuzo S, Almomani A, Boustany T, Kumar P Ann Gastroenterol. 2023; 36(3):327-332.

PMID: 37144010 PMC: 10152803. DOI: 10.20524/aog.2023.0794.

Proton Pump Inhibitors Use and Increased Risk of Spontaneous Bacterial Peritonitis in Cirrhotic Patients: A Retrospective Cohort Analysis.

Dahabra L, Kreidieh M, Abureesh M, Abou Yassine A, Deeb L Gastroenterology Res. 2022; 15(4):180-187.

PMID: 36128183 PMC: 9451581. DOI: 10.14740/gr1545.

Association Between Proton Pump Inhibitor Therapy and Spontaneous Bacterial Peritonitis Occurrence in Cirrhotic Patients: A Clinical Review.

Zhang M, Liu W, Xu X, Chen T, Qi J Curr Med Sci. 2022; 42(4):673-680.

PMID: 35870102 DOI: 10.1007/s11596-022-2607-3.

Correlation Between Proton Pump Inhibitors and the Complications of Liver Cirrhosis: A Systematic Review and Meta-Analysis.

Hwang S, Lee D, Koh S, Kim J, Park H, Kim B Turk J Gastroenterol. 2022; 33(1):44-52.

PMID: 35040787 PMC: 9128585. DOI: 10.5152/tjg.2022.20689.

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