Acid suppressive therapy is associated with spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis.
J Gastroenterol Hepatol. 2012 Nov 28. Epub 2012 Nov 28. PMID: 23190338
Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, OH, 44106.
BACKGROUND AND AIM: Proton pump inhibitors (PPI) and H(2) -receptor antagonists (H(2) RA) are frequently prescribed in hospitalized patients with cirrhosis. There are conflicting reports regarding the role of acid suppressive therapy in predisposing hospitalized patients with cirrhosis to spontaneous bacterial peritonitis (SBP).The aim of this meta-analysis was to evaluate the association between acid-suppressive therapy and the risk of SBP in hospitalized patients with cirrhosis. METHODS: We searched MEDLINE and 4 other databases for subject headings and text words related to SBP and acid-suppressive therapy. All observational studies that investigated the risk of SBP associated with PPI/H2RA therapy and utilized SBP as an endpoint were considered eligible. Data from the identified studies were combined by means of a random-effects model and odds ratios (ORs) were calculated. RESULTS: Eight studies (n=3,815 patients) met inclusion criteria. The risk of hospitalized cirrhotic patients developing SBP increased when using acid-suppressive therapy. The risk was greater with PPI therapy (n= 3,815; OR 3.15, 95% CI 2.09-4.74) as compared to those on H2RA therapy (n=562; OR 1.71, 95% CI 0.97- 3.01). CONCLUSIONS: Pharmacologic acid-suppression was associated with a greater risk of SBP in hospitalized patients with cirrhosis. Cirrhotic patients receiving a PPI have approximately 3 times the risk of developing SBP compared to those not receiving this medication. Prospective studies may help clarify this relationship and shed light on the mechanism(s) by which acid-suppressive therapy increases the risk of SBP in hospitalized patients with cirrhosis.