scholarly journals A70 ASSOCIATION BETWEEN PROTON PUMP INHIBITOR USE IN HOSPITALIZED CIRRHOTICS AND DEVELOPMENT OF HEPATIC ENCEPHALOPATHY AND SPONTANEOUS BACTERIAL PERITONITIS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 83-84
Author(s):  
P Tan ◽  
M Ukos ◽  
C Miller ◽  
J Lombardi ◽  
E M Kelly
Keyword(s):  
Hepatic Encephalopathy ◽  
Proton Pump ◽  
Variceal Bleeding ◽  
Spontaneous Bacterial Peritonitis ◽  
Relevant Information ◽  
Prescribing Patterns ◽  
Ulcer Disease ◽  
Bacterial Peritonitis ◽  
Significant Difference ◽  
History Of

Abstract Background Proton pump inhibitors (PPI) are commonly prescribed medications which are indicated in various different gastrointestinal (GI) diseases, including peptic ulcer disease, gastroesophageal reflux disorder and upper GI bleeding. There is some evidence to suggest that PPI use in cirrhosis may predispose to the development of hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP), albeit with some controversy. Aims We aim to conduct a retrospective epidemiological analysis of the association between PPI use in hospitalized patients with cirrhosis, and prevalence of HE and SBP. Methods This was a retrospective cohort study of 600 adult patients (mean age 61.4 (SD=12.2)) admitted the Ottawa Hospital between January 1, 2011 and December 31, 2015 with cirrhosis. A chart review was conducted and relevant information extracted. Results Average MELD-Na on admission was 16.2 (sd=6.7). 14.8% of patients had a history of HE, 5.0% SBP, 7.8% with history of hepatocellular carcinoma and 1.0% with history of hepatorenal syndrome. 28.5% of patients had a history of varices, of which 11.0% had previous variceal bleeding. 69.3% of patients were on a PPI during their hospitalization. Not surprisingly, patients admitted with variceal bleeding were more likely to be exposed to PPI in hospital (97.2% vs 63.2%, p<0.01) Patients with a diagnosis of cirrhosis prior to index admission were more likely to be on a PPI in hospital (p=0.001) and on discharge (p=0.001). Patients with ascites were less likely to be on a PPI than those without ascites (64.1% vs 77.6%, p<0.01). There was no significant correlation between in hospital PPI use and MELD score (p=0.42). Amongst patients on PPI in hospital, 85.9% remained on a PPI at discharge. Although numerically greater, no statistically significant differences were observed in terms of prevalence of HE (21.3% in patients on PPI vs 8.3% in those not on PPI (p=0.37)), nor SBP (5.7% on PPI vs. 3.7% in those not on PPI (p=0.29)). Conclusions We did not observe a significant difference in HE and SBP among this cohort of cirrhotic patients by in-hospital PPI use. We did however note significantly higher PPI use in patients with previous diagnosis of cirrhosis as compared to those who were newly diagnosed, as well as those whose admissions were related to bleeding. Patients with ascites had lower prevalence of PPI use. Prescribing patterns for PPIs in patients with cirrhosis warrant further attention, including clinical utility and longer-term risks and benefits of this therapy. Funding Agencies None

scholarly journals A222 ASSOCIATION BETWEEN PROTON PUMP INHIBITOR USE AND DEVELOPMENT OF HEPATIC ENCEPHALOPATHY AND SPONTANEOUS BACTERIAL PERITONITIS IN HOSPITALIZED PATIENTS WITH CIRRHOSIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 255-257
Author(s):  
P Tan ◽  
K Yau ◽  
M Ukos ◽  
C Miller ◽  
J Lombardi ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Proton Pump ◽  
Spontaneous Bacterial Peritonitis ◽  
Infectious Complications ◽  
Hospitalized Patients ◽  
Bacterial Peritonitis ◽  
History Of ◽  
Tract Infections

Abstract Background Proton pump inhibitors (PPIs) are commonly prescribed medications which are indicated in various different gastrointestinal (GI) diseases, including peptic ulcer disease, gastroesophageal reflux disorder and upper GI bleeding. There is some evidence to suggest that PPI use in cirrhosis may predispose to the development of hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP), albeit with some controversy. Aims We aim to conduct a retrospective epidemiological analysis of the association between PPI use in hospitalized patients with cirrhosis and prevalence of HE and SBP. Methods This was a retrospective cohort study of 953 adult patients (mean age 62.3 (SD=12.2)) with cirrhosis admitted to the Ottawa Hospital between January 1, 2011 and December 31, 2015. A chart review was conducted and relevant information extracted. Results Average MELD-Na on admission was 17.4 (SD = 7.5) with no significant differences when stratified by in-hospital PPI use (p=0.53). 14.7% of patients had a prior history of HE, 5.4% SBP, 31.6% ascites, 9.3% hepatocellular carcinoma and 1.2% hepatorenal syndrome. 26.4% of patients had a history of varices, of which 34.4% had previous variceal bleeding. 45.4% of patients were on a PPI prior to admission and 69.8% during their hospitalization. Patients with a previous history of HE (16.8% vs. 9.6% p=0.006), varices (31.4% vs. 14.2% p<0.001) and variceal bleed (11.6% vs. 3.1% p<0.001) were more likely to be exposed to a PPI in-hospital. Mortality rate during index admission was 19.4%. There was no significant association noted between the incidence of HE (31.2% vs. 25.0% p=0.06) or SBP (10.4% vs. 8.0% p=0.25) and in-hospital PPI use. There was also no significant association between PPI use and infectious complications, including bacteremia (8.6% vs. 7.6% p=0.63), pneumonia (12.7% vs. 12.5% p=0.95), urinary tract infections (9.2% vs. 6.6% p=0.19) and clostridium difficile (3.8% vs. 2.1% p=0.18). Patients on a PPI had greater in-hospital mortality (22.0% vs. 13. 5% p=0.002), although there was no significance between cause of death (p=0.31) nor death from infectious complications (18.5% vs. 23.1% p=0.52) between groups. Length of stay (LOS) was longer in patients exposed to PPI (median (IQR) 7 (4–17) vs 6 (3–13) p=0.03). Similar findings were noted on subgroup analysis of decompensated patients. Conclusions We did not observe a significant difference in HE, SBP or infectious complications among this cohort of cirrhotic patients by in-hospital PPI use. However, there was a significantly higher mortality rate noted in hospital and longer LOS, despite similar baseline MELD-Na and causes of death. Further study and judicious PPI prescribing practices in this vulnerable population of patients is warranted. Funding Agencies None

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.

Safety and Efficacy of Rifaximin in Prophylaxis of Spontaneous Bacterial Peritonitis: A Systematic Review and Meta-analysis

2019 ◽  
Vol 20 (4) ◽  
pp. 380-387 ◽  
Author(s):  
Amr Menshawy ◽  
Omar Mattar ◽  
Kirolos Barssoum ◽  
Ammar M. AboEl-Naga ◽  
Haitham Mohamed Salim ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Success Rate ◽  
Spontaneous Bacterial Peritonitis ◽  
Meta Analysis ◽  
Final Analysis ◽  
Effect Estimate ◽  
Analysis Model ◽  
Bacterial Peritonitis ◽  
Significant Difference

Aim: The role of rifaximin in the prevention of Spontaneous Bacterial Peritonitis (SBP) is not well studied. The aim of this meta-analysis was to evaluate the role of rifaximin in the prevention of SBP. Methods: A computerized literature search for relevant clinical trials was conducted during August 2017. Data on Frequency of SBP, the success rate of prevention of SBP, mortality rate, hepatorenal syndrome, septic shock, hepatic encephalopathy, and GIT bleeding were extracted and pooled as Risk Ratio (RR) with their 95% Confidence Interval (CI) in a meta-analysis model. Heterogeneity was assessed by Chi-square test. Results: Six studies involving 973 patients were included in the final analysis. The pooled effect estimate showed that the rifaximin plus norfloxacin group had less incidence of SBP (RR 0.58, 95% CI[0.37, 0.92], P=0.02) and hepatic encephalopathy (RR 0.38, 95% CI[0.17, 0.84], P=0.02) than the norfloxacin-based regimen group. No significant difference between rifaximin and norfloxacin in terms of frequency of SBP and success rate of primary prevention of SBP (RR 0.49, 95% CI [0.24, 1.01], P=0.05; RR1.21, 95% CI [0.95, 1.55], P=0.13, respectively). Conclusion: Based on our analysis, Rifaximin is a promising drug and appears to be a good alternative to norfloxacin in the prevention of SBP.

scholarly journals Prognostic Factors Associated with Mortality in Cirrhotic Patients with Bleeding Varices

2019 ◽  
Vol 5 (02) ◽  
pp. 46-52
Author(s):  
Alshaimaa Fathy Eldesouky ◽  
Mohamed Abd Elraoof Tawfik ◽  
Maha Mahmoud Hagras ◽  
Taher Eldemerdash Attia ◽  
Mohammed Elsayed Elhendawy
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Hepatic Encephalopathy ◽  
Serum Creatinine ◽  
Variceal Bleeding ◽  
Death Rate ◽  
Spontaneous Bacterial Peritonitis ◽  
Apache Ii ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients

Abstract Objective Bleeding gastroesophageal varices are a cause of high mortality among cirrhotic patients. Aim The aim of this study was to study prognostic factors for mortality in cirrhosis associated with variceal bleeding. Patients and Methods This prospective study was conducted on 100 cirrhotic patients admitted to the Tanta University Hospital with an acute first variceal bleeding episode. Baseline clinical, laboratory, and endoscopic findings were recorded at presentation. Results During the first 6 weeks 15 patients died, 3 following the initial bleed and 12 after an early rebleed. At 6 months, a further 21 patients had died. Statistical analysis utilizing the baseline data revealed that high early death rate was associated with number of blood units transfused, lower systolic blood pressure, thrombocytopenia, increased serum creatinine and international normalized ratio (INR). High MELD, AIMS56, acute physiology and chronic health evaluation II (APACHE II) and ROCKall scores were risk factors for mortality. Risk factors for early rebleeding included presence of diabetes mellitus, leucocytosis, high Child score, model for end-stage liver disease (MELD), AIMS56, and sepsis-associated organ failure assessment (SOFA) scores. A high Child score, presence of ascites, and associations such as hepatic encephalopathy and spontaneous bacterial peritonitis, leucocytosis, elevated alanine transaminase, aspartate transaminase, bilirubin, INR, and creatinine as well as low albumin were associated with decreased survival. Conclusion High MELD, AIMS56, APACHE II, and ROCKall scores were risk factors for mortality after acute variceal bleeding. High death rate during the first 6 weeks is associated with anemia, hypotension, thrombocytopenia, increased serum creatinine, and INR. Decreased survival at 6 months is associated with increased Child score, presence of ascites and associations such as hepatic encephalopathy and spontaneous bacterial peritonitis.

scholarly journals Primary Prophylaxis to Prevent the Development of Hepatic Encephalopathy in Cirrhotic Patients with Acute Variceal Bleeding

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Fátima Higuera-de-la-Tijera ◽  
Alfredo I. Servín-Caamaño ◽  
Francisco Salas-Gordillo ◽  
José L. Pérez-Hernández ◽  
Juan M. Abdo-Francis ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Variceal Bleeding ◽  
Primary Prophylaxis ◽  
Controlled Clinical Trial ◽  
Double Blind ◽  
E Coli ◽  
Bacterial Peritonitis ◽  
Significant Difference ◽  
Cirrhotic Patients ◽  
Better Than

Background and Aim. Variceal bleeding is the second most important precipitating factor related to the development of episodic hepatic encephalopathy; but to date there are no recommendations to prevent this complication. The aim of this study was to compare if primary prophylaxis with lactulose or L-ornithine L-aspartate or rifaximin, in cirrhotic patients with variceal bleeding, is better than placebo for avoiding the development of hepatic encephalopathy. Methods. A randomized, double-blind, placebo-controlled clinical trial (ClinicalTrials.gov identifier: NCT02158182) which included cirrhotic patients with variceal bleeding, without minimal or clinical hepatic encephalopathy at admission. Findings. 87 patients were randomized to one of four groups. The basal characteristics were similar between groups. Comparatively with placebo, the frequency with regard to the development of hepatic encephalopathy was as follows: lactulose (54.5% versus 27.3%; OR = 0.3, 95% CI 0.09-1.0; P = 0.06); L-ornithine L-aspartate (54.5% versus 22.7%, OR = 0.2, 95% CI 0.06-0.88; P = 0.03); rifaximin (54.5% versus 23.8%; OR = 0.3, 95% CI 0.07-0.9; P = 0.04). There was no significant difference between the three groups receiving any antiammonium drug (P = 0.94). In the group receiving lactulose, 59.1% had diarrhea, and 45.5% had abdominal discomfort, bloating, and flatulence. Two patients (10%) treated with lactulose and a patient (4.5%) in the placebo group developed spontaneous bacterial peritonitis due to E. coli; one of them died due to recurrent variceal bleeding. There were no other adverse effects. Conclusions. Antiammonium drugs, particularly L-ornithine L-aspartate and rifaximin, proved to be effective in preventing the development of hepatic encephalopathy in those cirrhotic patients with variceal bleeding.

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