Sa1014 Role of Proton Pump Inhibitors in the Development of Spontaneous Bacterial Peritonitis Amongst Cirrhotics; a Retrospective Cohort Study

Aditi, Anupam; Crippin, Jeffrey S.; Abhishek, Ankur

doi:10.1016/s0016-5085(12)63667-1

Cited by 6 publications

(9 citation statements)

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“…Twelve studies were published in journals (Campbell et al, 2008;Bajaj et al, 2009;Choi et al, 2011;Goel et al, 2012;van Vlerken et al, 2012;de Vos et al, 2013;Kwon et al, 2014;Merli et al, 2014;Min et al, 2014;Miura et al, 2014;O'Leary et al, 2014;Ratelle et al, 2014) and 5 studies were reported as conference abstracts (Northup et al, 2008;Bulsiewicz et al, 2009;Aditi et al, 2012;Terg et al, 2012;Mandorfer et al, 2014). We included 8 retrospective cohort studies, 6 case-control studies, and 3 prospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

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Proton pump inhibitor use and risk of spontaneous bacterial peritonitis in cirrhotic patients: a systematic review and meta-analysis

et al. 2015

Genet. Mol. Res.

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ABSTRACT. We used a meta-analysis approach to investigate the association between proton pump inhibitor (PPI) use and risk of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. We searched Ovid Medline, Embase, and the Cochrane Library to identify eligible studies. We included studies that compared cirrhotic patients who did or did not use PPIs. The primary outcome was SBP, and the secondary outcome was overall bacterial infection. Results were pooled using random-effect models. This process led to identification of 12 journal articles and 5 conference abstracts. The pooled data showed that PPI use in patients with cirrhosis and ascites was significantly associated with an increased risk of SBP [odds ratio (OR) = 2.17; 95% confidence interval (CI) = 1.46-3.23; P < 0.05; I 2 = 85.6%] and overall risk of bacterial infection (OR = 1.98; 95%CI = 1.36-2.87; P < 0.05; I 2 = 0). Subgroup analysis revealed that journal articles and studies reporting adjusted effect estimates demonstrated that PPI users had a significantly increased risk of SBP (OR = 2.13; 95%CI = 1.61-2.82; P < 0.05; I 2 = 29.4%; and OR = 1.98; 95%CI = 1.42-2.77; P < 0.05; I 2 = 67%, respectively). In conclusion, PPI use increased the risk of SBP and overall bacterial infection in patients with cirrhosis and ascites. PPIs should be administered after careful assessment of the indications in cirrhotic patients. Future well-designed prospective studies are warranted to clarify the dose relationships and to compare infection risks associated with different classes of PPIs.

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Section: Resultsmentioning

confidence: 99%

“…Numerous studies have suggested that PPI use by cirrhotic patients may increase the risk of SBP (Bajaj et al, 2009;de Vos et al, 2013;Min et al, 2014;Ratelle et al, 2014). However, some studies have drawn opposite conclusions (Campbell et al, 2008;Aditi et al, 2012;Terg et al, 2012;van Vlerken et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Proton pump inhibitor use and risk of spontaneous bacterial peritonitis in cirrhotic patients: a systematic review and meta-analysis

et al. 2015

Genet. Mol. Res.

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“…The developed practical guidance is based on information from the product information (Table ) and data extracted from 69 articles included in the literature review (Figure ) . Twelve of the included studies focused on pharmacokinetics (Table ), 51 on safety, and six studied both safety and pharmacokinetics of PPIs.…”

Section: Resultsmentioning

confidence: 99%

“…Thirty‐seven articles studied the safety of PPIs as a group in patients with cirrhosis (Table S1) . These studies mostly focused on the risk of spontaneous bacterial peritonitis or infections in general.…”

Section: Resultsmentioning

confidence: 99%

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Safe use of proton pump inhibitors in patients with cirrhosis

Weersink

Bouma

Burger

et al. 2018

Brit J Clinical Pharma

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AimsProton pump inhibitors (PPIs) belong to the most frequently used drugs, also in patients with cirrhosis. PPIs are extensively metabolized by the liver, but practice guidance on prescribing in cirrhosis is lacking. We aim to develop practical guidance on the safe use of PPIs in patients with cirrhosis.MethodsA systematic literature search identified studies on the safety (i.e. adverse events) and pharmacokinetics of PPIs in cirrhotic patients. This evidence and data from the product information was reviewed by an expert panel who classified drugs as safe; no additional risks known; additional risks known; unsafe; or unknown. Guidance was aimed at the oral use of PPIs and categorized by the severity of cirrhosis, using the Child–Turcotte–Pugh (CTP) classification.ResultsA total of 69 studies were included. Esomeprazole, omeprazole and rabeprazole were classified as having ‘no additional risks known’. A reduction in maximum dose of omeprazole and rabeprazole is recommended for CTP A and B patients. For patients with CTP C cirrhosis, the only PPI advised is esomeprazole at a maximum dosage of 20 mg per day. Pantoprazole and lansoprazole were classified as unsafe because of 4‐ to 8‐fold increased exposure. The use of PPIs in cirrhotic patients has been associated with the development of infections and hepatic encephalopathy and should be carefully considered.ConclusionsWe suggest using esomeprazole, omeprazole or rabeprazole in patients with CTP A or B cirrhosis and only esomeprazole in patients with CTP C. Pharmacokinetic changes are also important to consider when prescribing PPIs to vulnerable, cirrhotic patients.

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Proton pump inhibitor therapy and its association with spontaneous bacterial peritonitis incidence and mortality: A meta-analysis

Yu¹,

Tang²,

Jiang

et al. 2016

Digestive and Liver Disease

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Sa1014 Role of Proton Pump Inhibitors in the Development of Spontaneous Bacterial Peritonitis Amongst Cirrhotics; a Retrospective Cohort Study

Cited by 6 publications

References 0 publications

Proton pump inhibitor use and risk of spontaneous bacterial peritonitis in cirrhotic patients: a systematic review and meta-analysis

Proton pump inhibitor use and risk of spontaneous bacterial peritonitis in cirrhotic patients: a systematic review and meta-analysis

Safe use of proton pump inhibitors in patients with cirrhosis

Proton pump inhibitor therapy and its association with spontaneous bacterial peritonitis incidence and mortality: A meta-analysis

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