Background Proton pump inhibitors (PPIs) are commonly prescribed for cirrhotic patients. However, the use of PPIs in these patients may increase the risk of bacterial infection. The current study aimed to investigate the risk of developing pneumonia among cirrhotic patients exposed to PPIs. Methods A literature search was independently conducted by 2 investigators using the MEDLINE and EMBASE databases up to September 2019. To be eligible, a study had to be an observational (cohort, case-control or cross-sectional) study that included one group of cirrhotic patients with PPI use and another group of cirrhotic patients without PPI use. Effect estimates of the association between PPI use and pneumonia had to be reported. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. Results Of 1947 articles identified from the 2 databases, 3 cohort and 5 cross-sectional studies with 40,295 participants met the eligibility criteria and were included in the meta-analysis. The pooled analysis found that cirrhotic patients with a history of PPI use had a significantly higher risk of developing pneumonia than those without PPI use, with a pooled risk ratio of 1.36 (95% confidence interval 1.00-1.85; I 2 47%). Conclusion A significantly increased risk of pneumonia among cirrhotic patients exposed to PPIs was demonstrated in this study.

Background Ischemic colitis is a relatively common gastrointestinal disease caused by hypoperfusion of the colon. Recently, studies have suggested an association between heart failure (HF) and ischemic colitis, even though the magnitude of the reported association varied considerably across the studies. This systematic review and meta-analysis were performed to comprehensively explore whether patients with HF are at a higher risk of ischemic colitis compared with individuals without HF by combining the results of all available observational studies. Methods Systematic literature review was performed using EMBASE, MEDLINE and Google Scholar database up to May 2020. Eligible studies could be any observational ones that evaluated whether patients with HF have a higher risk of ischemic colitis than individuals without HF. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. Results The systematic review identified 7 case-control studies and 1 cross-sectional study. The pooled analysis found that patients with HF had a significantly higher risk of ischemic colitis with the pooled odds ratio of 3.42 (95% confidence interval 1.49-7.82; I 2 96%). Funnel plot was relatively symmetric and was not suggestive of presence of publication bias. Conclusion A significantly increased risk of ischemic colitis among patients with HF was demonstrated in this systematic review and meta-analysis.