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 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.

63 Proton Pump Inhibitor (PPI) Use Is Independently Associated with Spontaneous Bacterial Peritonitis (SBP) in Cirrhotics with Ascites

2009 ◽  
Vol 136 (5) ◽  
pp. A-11 ◽  
Author(s):  
William J. Bulsiewicz ◽  
John R. Scherer ◽  
Joseph M. Feinglass ◽  
Colin W. Howden ◽  
Steven L. Flamm
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Spontaneous Bacterial Peritonitis ◽  
Bacterial Peritonitis

S1915 Proton Pump Inhibitor (PPI) use is Associated With Spontaneous Bacterial Peritonitis (SBP) in Cirrhosis (Cir)

2010 ◽  
Vol 138 (5) ◽  
pp. S-816-S-816 ◽  
Author(s):  
Gati A. Goel ◽  
Abhishek Deshpande ◽  
Rocio Lopez ◽  
Geraldine S. Hall ◽  
David van Duin ◽  
...  
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Spontaneous Bacterial Peritonitis ◽  
Bacterial Peritonitis

scholarly journals Validation of a Short Questionnaire in English and French for Use in Patients with Persistent Upper Gastrointestinal Symptoms Despite Proton Pump Inhibitor Therapy: The Pass (Proton Pump Inhibitor Acid Suppression Symptom) Test

2005 ◽  
Vol 19 (6) ◽  
pp. 350-358 ◽  
Author(s):  
David Armstrong ◽  
Sander JO Veldhuyzen van Zanten ◽  
Sharon A Chung ◽  
Colin M Shapiro ◽  
Sukhjeet Dhillon ◽  
...  
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Reflux Disease ◽  
Content Validity ◽  
Gastrointestinal Symptoms ◽  
Acid Suppression ◽  
Persistent Symptoms ◽  
French Speaking ◽  
Upper Gastrointestinal Symptoms ◽  
Test Retest Reliability

BACKGROUND: The management of persistent symptoms during acid suppression therapy in patients with gastroesophageal reflux disease or dyspepsia might be improved if patient-physician communication regarding the presence and character of these persistent symptoms were facilitated.AIM: To validate a short, simple questionnaire (the Proton pump inhibitor [PPI] Acid Suppression Symptom [PASS] test), in English and French, to identify patients with persistent acid-related symptoms during PPI therapy and document their response to a change in therapy.METHODS: Patients with persistent acid-related symptoms on PPI therapy were interviewed to produce a draft, five-item questionnaire; content validity was evaluated by focus groups comprising English- and French-speaking patients. Psychometric validity was subsequently evaluated in a multicentre, family practice-based study of English- and French-speaking patients with persistent acid-related upper gastrointestinal symptoms despite PPI therapy. The PASS test, Global Overall Symptom scale, Gastrointestinal Symptom Rating Scale (GSRS), Quality of Life in Reflux and Dyspepsia questionnaire and Reflux Disease Questionnaire were completed at baseline and repeated after one week while patients continued their original PPI therapy. All patients then received esomeprazole 40 mg once daily for four weeks, after which all questionnaires and an evaluation of overall treatment effect were completed.RESULTS: Content validity was established in 20 English- and 16 French-speaking patients. Psychometric validation in 158 English- and 113 French-speaking patients revealed good-to-excellent test-retest reliability coefficients: 0.76 for English; 0.68 for French. For construct validity, the PASS test showed moderate-to-high correlation with the GSRS scale (0.51 for English; 0.43 for French). After four weeks of therapy, the PASS test score fell to zero in 30% of English- and 33% of French-speaking patients, while the Global Overall Symptom score fell to one (no symptoms) in 32% of patients (English- and French-speaking); the PASS test demonstrated good responsiveness in comparison with the GSRS, Reflux Disease Questionnaire and Quality of Life in Reflux and Dyspepsia questionnaire.CONCLUSION: The five-item PASS test is a valid tool for the evaluation of persistent acid-related symptoms in patients receiving PPI therapy. It demonstrates good content validity, test-retest reliability, responsiveness and construct validity in both English and French forms. The PASS test is a simple, clinically applicable tool for the identification of patients with persistent acid-related symptoms during therapy and the assessment of their responses to a change in therapy.

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