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

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.

Download Full-text

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

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2014/751921 ◽

2014 ◽

Vol 28 (6) ◽

pp. 330-334 ◽

Cited By ~ 18

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.

Download Full-text

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

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.4.3476 ◽

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.

Download Full-text

Su1494 Non-Selective Beta Blockers Have No Protective Effect Against Spontaneous Bacterial Peritonitis in Cirrhotic Patients: A Systematic Review and Meta-Analysis

Gastroenterology ◽

10.1016/s0016-5085(16)33750-7 ◽

2016 ◽

Vol 150 (4) ◽

pp. S1110

Author(s):

Muhammad Ali Khan ◽

Faisal Kamal ◽

Bilal Ali ◽

Scott Duncan ◽

Claudio Tombazzi ◽

...

Keyword(s):

Systematic Review ◽

Protective Effect ◽

Spontaneous Bacterial Peritonitis ◽

Beta Blockers ◽

Meta Analysis ◽

Bacterial Peritonitis ◽

Cirrhotic Patients

Download Full-text

Clinical features and outcome of spontaneous bacterial peritonitis in HIV-infected cirrhotic patients: a case-control study

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-006-0136-9 ◽

2006 ◽

Vol 25 (5) ◽

pp. 291-298 ◽

Cited By ~ 16

Author(s):

E. Shaw ◽

J. Castellote ◽

M. Santín ◽

X. Xiol ◽

G. Euba ◽

...

Keyword(s):

Clinical Features ◽

Spontaneous Bacterial Peritonitis ◽

Case Control Study ◽

Case Control ◽

Bacterial Peritonitis ◽

Cirrhotic Patients ◽

Control Study

Download Full-text

The association between pre hospital use of proton pump inhibitors and spontaneous bacterial peritonitis in patients presenting with liver cirrhosis.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.11.4229 ◽

2019 ◽

Vol 26 (11) ◽

pp. 2003-2008

Author(s):

Muhammad Hussain Baloch ◽

Riaz Hussain Awan ◽

Seema Nayab ◽

Khadim Hussain Awan ◽

Faqir Muhammad Awan

Keyword(s):

Liver Cirrhosis ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Spontaneous Bacterial Peritonitis ◽

Operational Definition ◽

Endoscopic Variceal Ligation ◽

Bacterial Peritonitis ◽

Cirrhotic Patients ◽

Control Study ◽

Hospital Use

Objectives: To determine the association between pre hospital use of proton pump inhibitors and spontaneous bacterial peritonitis in patients presenting with liver cirrhosis. Study Design: Case control study. Setting: Department of Gastroenterology at Liaquat National Hospital Karachi. Period: Six months (From 1st – March-2017 to 31st – August-2017). Material and Methods: There were 120 patients with cirrhosis were included in this study. Sixty patients were cases with spontaneous bacterial peritonitis (SBP) and 60 patients were control without spontaneous bacterial peritonitis. All patients were interviewed for pre hospital intake of PPI (as per operational definition). All the data was entered on predesigned proforma (attached). Results: The average age of the patients was 42.47±9.87 years. Rate of PPI use was significantly higher among cases with SBP (46.7%) as compared to the patients without SBP (23.3%). Conclusion: In conclusion, PPI use (acid suppression) was associated with the development of SBP in cirrhotic patients with ascites. We recommend that PPI indications in cirrhotic patients should be frequently re-evaluated with particular attention devoted to duration of use, especially following endoscopic variceal ligation (EVL).

Download Full-text