Faculty Collaboration Database

Association of proton pump inhibitor therapy with spontaneous bacterial peritonitis in cirrhotic patients with ascites. Am J Gastroenterol 2009 May;104(5):1130-4

Date

04/02/2009

Pubmed ID

19337238

DOI

10.1038/ajg.2009.80

Scopus ID

2-s2.0-66949151786 (requires institutional sign-in at Scopus site)   187 Citations

Abstract

OBJECTIVES: Spontaneous bacterial peritonitis (SBP) is a frequent complication of cirrhosis. Bacterial contamination of ascites fluid leading to SBP is caused by bacterial translocation with subsequent bacteremia. Proton pump inhibitors (PPIs) suppress gastric acid secretion, allowing bacterial colonization of the upper gastrointestinal tract, and may predispose to bacterial overgrowth and translocation. The aim of this study was to determine whether PPI use in cirrhotics with ascites is associated with SBP.

METHODS: A retrospective case-control study was performed. Seventy cirrhotics admitted with paracentesis-proven SBP between 2002 and 2007 were matched 1:1 (for age and Child's class) with comparable cirrhotics with ascites who were admitted for conditions other than SBP. We excluded patients on chronic antibiotic prophylaxis or with antecedent gastrointestinal bleeding. Outpatient PPI use at the time of admission was compared between groups, and the effect of covariates was analyzed.

RESULTS: Patients with SBP had a significantly higher rate of prehospital PPI use (69%) compared with ascitic cirrhotics hospitalized without SBP (31%, P = 0.0001). There was no significant difference in demographics, diabetes, etiology, or survival between groups. On multivariate analysis, PPI use was independently associated with SBP (odds ratio (OR) 4.31, confidence interval (CI) 1.34-11.7), and ascitic fluid protein was protective (OR 0.1, CI 0.03-0.25). In total, 47% of cirrhotic patients receiving PPI in this study had no documented indication for PPI treatment.

CONCLUSIONS: PPI therapy is associated with SBP in patients with advanced cirrhosis. Prospective studies are needed to determine whether PPI avoidance can reduce the incidence of SBP and improve outcomes.

Author List

Bajaj JS, Zadvornova Y, Heuman DM, Hafeezullah M, Hoffmann RG, Sanyal AJ, Saeian K

Author

Kia Saeian MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Age Distribution
Aged
Ascites
Bacteremia
Case-Control Studies
Comorbidity
Confidence Intervals
Female
Gram-Negative Bacterial Infections
Gram-Positive Bacterial Infections
Humans
Incidence
Liver Cirrhosis
Logistic Models
Male
Middle Aged
Odds Ratio
Peritonitis
Probability
Prognosis
Proton Pump Inhibitors
Retrospective Studies
Risk Assessment
Severity of Illness Index
Sex Distribution
Survival Analysis