Abstract
Introduction: Proton Pump Inhibitors (PPIs) are widely prescribed in patients with cirrhosis for a variety of indications and may be overused. Spontaneous Bacterial Peritonitis (SBP) is a common but serious complication in patients with cirrhosis. Studies evaluating the risk of SBP in patients on PPIs have shown conflicting results. We performed a systematic review and meta-analysis to study the association between PPIs and the risk of SBP. Methods: A systematic search of Medline, Embase, and Web of Science was performed up to June 2018. Studies (case series, case-control, cohort studies and clinical trials) assessing the association between PPI exposure and SBP in patients with cirrhosis were included. Summary Odds Ratio estimates with 95% confidence intervals (CIs) were calculated with the random-effects model using Review Manager version 5.3 (Cochran Inc). Results: Twenty-two studies with a total of 12,265 patients with cirrhosis were included. Of those, 4748 were exposed to PPIs. The rate of SBP in patients on PPIs was 16.9% (807/4748), compared to 15.2% (1147/7517) in patients not on PPIs. Meta-analysis showed an increased risk of SBP in patients using PPIs with an OR (2.05, 95% Cl 1.64-2.56, I2= 60%). Of the included studies, 19 studies had adjusted for potential confounders. Analysis of studies that had adjusted for potential confounders also revealed an increased risk of SBP with the use of PPIs (OR 1.74, 95% Cl 1.41-2.16, I2=53%). Risk remained significantly high in subgroup analysis of only cohort studies (OR 1.49, 95% Cl 1.26-1.76, I2=3%). Conclusion: Meta-analyses of existing studies suggest that use of PPIs is associated with an increased risk of SBP. The risk remains high even after adjusting for potential confounders. It may be reasonable to re-evaluate the need of PPIs in patients with cirrhosis.1015 Figure 1 No Caption available.
Published Version
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