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Canadian Journal of Gastroenterology and Hepatology
Volume 28, Issue 6, Pages 330-334
http://dx.doi.org/10.1155/2014/751921
Original Article

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

Mélissa Ratelle,1 Sylvie Perreault,2 Jean-Pierre Villeneuve,3 and Lydjie Tremblay1,2

1Department of Pharmacy, Centre Hospitalier de l’Université de Montréal, Canada
2Université de Montréal, Department of Medicine, Hôpital St-Luc, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
3Division of Hepatology, Department of Medicine, Hôpital St-Luc, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada

Received 23 July 2013; Accepted 28 April 2014

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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 the Centre Hospitalier de l’Université de Montréal in 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.