scholarly journals Association Between Proton Pump Inhibitor Use and Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites

2014 ◽  
Vol 28 (6) ◽  
pp. 330-334 ◽  
Author(s):  
Mélissa Ratelle ◽  
Sylvie Perreault ◽  
Jean-Pierre Villeneuve ◽  
Lydjie Tremblay
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Spontaneous Bacterial Peritonitis ◽  
Inclusion Criteria ◽  
Retrospective Case ◽  
Bacterial Peritonitis ◽  
Increased Risk ◽  
Pugh Class ◽  
Cirrhotic Patients ◽  
Control Study

BACKGROUND: There are data suggesting a link between proton pump inhibitor (PPI) use and the development of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites; however, these data are controversial.OBJECTIVE: To assess whether the use of PPIs in cirrhotic patients with ascites is associated with an increased risk for SBP.METHODS: A retrospective case-control study (June 2004 to June 2010) was conducted at theCentre Hospitalier de l’Université de Montréalin Montreal, Quebec. Fifty-one cirrhotic patients admitted with paracentesis-proven SBP (≥250 neutrophils/mm3), occurring within seven days of hospital admission, met the inclusion criteria. These patients were matched 1:2 (for age, Child-Pugh class and year of admission) with 102 comparable cirrhotic patients with ascites who were admitted for conditions other than SBP.RESULTS: Patients with SBP had a significantly higher rate of pre-hospital PPI use (60.8%) compared with cirrhotic patients without SBP (42.2%; P=0.03). On multivariate analysis, PPI use was the only factor independently associated with SBP (OR 2.09 [95% CI 1.04 to 4.23]; P=0.04). Thirty-five (35%) patients in both groups had no documented indication for PPI use in their charts. Forty-five percent of the remaining cirrhotic patients with SBP had an inappropriate indication, as defined in the protocol, for PPI use compared with 25% of controls.CONCLUSIONS: Cirrhotic patients with SBP were twice as likely to have taken PPIs than patients without SBP. These findings reinforce the association between PPI use and SBP observed in other studies. A high percentage of cirrhotic patients were taking a PPI without any documented indication.

scholarly journals Determining the Risk of Spontaneous Bacterial Peritonitisdue to increase use of Proton Pump Inhibitors among cirrhotic patients with ascites

2021 ◽  
Vol 37 (4) ◽  
Author(s):  
Bashir Ahmed Shaikh ◽  
Zahid Ali Shaikh ◽  
Aftab Hussain Shah ◽  
Aneel Kumar
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Spontaneous Bacterial Peritonitis ◽  
Polymorphonuclear Neutrophil ◽  
Retrospective Case ◽  
Medical College ◽  
Creative Commons ◽  
Bacterial Peritonitis ◽  
History Of ◽  
Cirrhotic Patients

Objectives: The current study aimed to determine the Spontaneous Bacterial Peritonitis (SBP) risk due to increased use of Proton Pump Inhibitors (PPIs) among cirrhotic patients with ascites. Methods: This retrospective case-control study was conducted at Chandka Medical College & Hospital, Larkana from March 2013 to February 2014, involving 215 cirrhotic patients with ascites. Paracentesis was performed to distinguish cirrhotic patients with SBP and Polymorphonuclear Neutrophil (PMN) count ≥ 250 neutrophils/mm3 (cases) and non-SBP with PMN count < 250 neutrophils/mm3 (controls). The demographic details, history of PPIs use before admission and duration of Chronic Liver Disease (CLD) were inquired and statistical analysis was carried through SPSS Version 23.0. Results: Increased pre-hospital PPI intake was observed among cirrhotic patients with SBP (69.8%) as compared to those without SBP (48.8%; p = 0.014). The mean duration of PPI use was 19.16 ± 4.772 days, and it was more significant among older cirrhotic patients (p < 0.05). Increased duration of CLD was observed among PPI users, i.e. 20.47 ± 6.305 months vs. 18.95 ± 5.527 months among non-PPI users (p < 0.05). Conclusions: Our results show that cirrhotic patients with ascites consuming PPIs are more likely to develop SBP as compared to non-PPI users. doi: https://doi.org/10.12669/pjms.37.4.3476 How to cite this:Shaikh BA, Shaikh ZA, Shah AH, Kumar A. Determining the Risk of Spontaneous Bacterial Peritonitis due to increase use of Proton Pump Inhibitors among cirrhotic patients with ascites. Pak J Med Sci. 2021;37(4):---------.   doi: https://doi.org/10.12669/pjms.37.4.3476 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Proton pump inhibitor: a risk factor for spontaneous bacterial peritonitis in Indian cirrhotics decompensated with ascites

2019 ◽  
Vol 7 (2) ◽  
pp. 378
Author(s):  
Akash Rajender ◽  
Priyanka Choudhary ◽  
Saumya Mathur ◽  
Rajat Bhargava ◽  
Shalini Upadhyay ◽  
...  
Keyword(s):  
Risk Factor ◽  
Spontaneous Bacterial Peritonitis ◽  
Beta Blockers ◽  
Bacterial Colonization ◽  
Study Groups ◽  
P Value ◽  
Retrospective Case ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients ◽  
Control Study

Background: Spontaneous bacterial peritonitis (SBP) is common complication of cirrhosis caused by bacterial translocation. Bacterial colonization and overgrowth may occur in GI tract on suppression of gastric acid secretion. Beta-blockers have been postulated to reduce intestinal permeability. There is no significant Indian study to evaluate association of PPI with SBP in cirrhotic ascites. We aimed to assess the effect of PPI in cirrhotic patients decompensated with ascites.Methods: A retrospective case control study (January 2016 to April 2018), evaluated subjects with cirrhosis and ascites. Two study groups of cirrhotic subjects with and without SBP were formed. In each of the two study groups, 143 subjects, were enrolled by matching for age, year of admission, Child-Pugh-Turcotte (CTP) class after considering the inclusion and exclusion criteria. PPI use and various other correlates were compared in both study groups. SPSS ver 24.0 was used for statistical analysis.Results: About 69.23% subjects were using PPI prior to admission in SBP group, which was significant compared to only 31.47% in cirrhotics without SBP (p 0.003). On multivariate analysis PPI use was an independent risk factor for SBP (OR 2.24, 95% CI: 1.01-4.24; p value 0.033) and beta blocker use was protective (OR 0.58; 95% CI: 0.4-0.8; p 0.001).Conclusions: PPI use doubles the risk of development of SBP in cirrhotics decompensated with ascites. In contrast, Beta blockers use significantly lowers the risk of SBP.

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

2018 ◽  
Vol 26 (2) ◽  
pp. 83-89 ◽  
Author(s):  
Abdel-Naser Elzouki ◽  
Nadia Neffati ◽  
Fatma A. Rasoul ◽  
Ali Abdallah ◽  
Muftah Othman ◽  
...  
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Spontaneous Bacterial Peritonitis ◽  
Bacterial Peritonitis ◽  
Increased Risk ◽  
Cirrhotic Patients

Proton Pump Inhibitor Use and Association with Spontaneous Bacterial Peritonitis in Patients with Cirrhosis and Ascites

2012 ◽  
Vol 46 (10) ◽  
pp. 1413-1418 ◽  
Author(s):  
Jolene F Siple ◽  
Jessica M Morey ◽  
Tracy E Gutman ◽  
Kathy L Weinberg ◽  
Peggie D Collins
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Spontaneous Bacterial Peritonitis ◽  
Meta Analysis ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Acid Suppression ◽  
Data Sources ◽  
Bacterial Peritonitis ◽  
Increased Risk

Objective: To evaluate the literature regarding the efficacy and safety of proton pump inhibitors (PPIs) when they are used in patients with cirrhosis and ascites. Data Sources: A literature search was conducted using MEDLINE (1966-May 2012) and Web of Science (1990-May 2012) with the terms proton pump inhibitor, antisecretory therapy, cirrhosis, ascites, spontaneous bacterial peritonitis, and Clostridium difficile. The search was restricted to articles published in English on the use of PPIs in humans. Reference citations from identified published articles were reviewed for relevant information. Study Selection and Data Extraction: All articles in English identified from the data sources were evaluated for inclusion. One case series, 8 retrospective case-control trials, and 1 meta-analysis were identified. Data Synthesis: Cirrhosis may cause complications such as portal hypertension, esophageal varices, and ascites. Patients may be prescribed PPIs without clear indications or because of their propensity to develop upper gastrointestinal symptoms and bleeding. However, gastric acidity is a major nonspecific defense mechanism and there is insufficient evidence on the need for chronic acid suppression in patients with cirrhosis. It is postulated that the portal hypertensive environment in cirrhosis and the acid suppression from PPIs can increase the risk of spontaneous bacterial peritonitis and C. difficile infection in patients with cirrhosis with ascites. Several retrospective studies and 1 meta-analysis have confirmed this association. Conclusions: Patients with cirrhosis and ascites should be monitored carefully while on PPIs for a possible increased risk of infection from spontaneous bacterial peritonitis and C. difficile. Prospective randomized trials are needed to confirm this association. Clinicians should be aware of this lesser known adverse effect of PPIs.

scholarly journals Relationship between proton pump inhibitor therapy and spontaneous bacterial peritonitis in cirrhotic patients with ascites

Kanzo ◽  
2014 ◽  
Vol 55 (9) ◽  
pp. 530-536
Author(s):  
Shuichi Matsumoto ◽  
Naoho Takizawa ◽  
Yasunari Kaneyama ◽  
Hitoki Miyai ◽  
Nobuhiro Kodama ◽  
...  
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Spontaneous Bacterial Peritonitis ◽  
Proton Pump Inhibitor Therapy ◽  
Inhibitor Therapy ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients

Association of Proton Pump Inhibitor Therapy With Spontaneous Bacterial Peritonitis in Cirrhotic Patients With Ascites

2009 ◽  
Vol 104 (5) ◽  
pp. 1130-1134 ◽  
Author(s):  
Jasmohan S Bajaj ◽  
Yelena Zadvornova ◽  
Douglas M Heuman ◽  
Muhammad Hafeezullah ◽  
Raymond G Hoffmann ◽  
...  
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Spontaneous Bacterial Peritonitis ◽  
Proton Pump Inhibitor Therapy ◽  
Inhibitor Therapy ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients
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