Abstract
Many studies and meta-analyses have investigated the associations among proton pump inhibitors (PPIs), spontaneous bacterial peritonitis (SBP), portosystemic encephalopathy (PSE), and other infections. However, these studies had limitations, including the omission of several relevant studies and drawing conclusions, based on the abstracts without consulting the full-text of the articles. To evaluate the association between PPIs and complications arising from cirrhosis and risks of PPI use in patients with cirrhosis. Data were extracted from the EMBASE, PubMed, Cochrane, and Google Scholar databases. The Newcastle-Ottawa scale was used to assess the quality of the selected studies. A total of 29 studies (13 case-control and 16 cohort studies) involving 20,484 patients were included in the meta-analysis. The total relative risk (RR) for the 23 studies which investigated SBP was 1.31, and the 95% CI was 1.10-1.55 (I2 = 73.0%). The total RR for the 7 studies which examined PSE was 1.25 (95% CI 0.85-1.84, I2 = 96.1%). For the 7 studies which analyzed overall infection, the total RR was 1.37 (95% CI 1.07-1.76, I2 = 79.3%). The RR for the 2 cohort studies that assessed mortality was 1.39 (95% CI 0.85-2.27, I2 = 0.0%). PPI use in cirrhosis patients increased the SBP and overall infection risk. PPIs should be considered with appropriate indications when the benefits exceed the risks in cirrhosis patients with ascites.
Highlights
Proton pump inhibitors (PPIs) are effective gastric acid suppressors, and play a pivotal role in the treatment of peptic ulcer disease, gastric bleeding, GERD, and Helicobacter pylori (H. pylori) infection [1, 2]
The total relative risk (RR) for the 23 studies analyzing spontaneous bacterial peritonitis (SBP) was 1.40; the 95% confidence interval (CI) was 1.22 – 1.61 (I2 = 56.6%, P < 0.001)
The use of PPIs in patients with cirrhosis increased the risk of SBP, but there was significant heterogeneity among patients in sta
Summary
Proton pump inhibitors (PPIs) are effective gastric acid suppressors, and play a pivotal role in the treatment of peptic ulcer disease, gastric bleeding, GERD, and Helicobacter pylori (H. pylori) infection [1, 2]. Gastric acid aids in digestion and sterilizes the digestive tract by removing pathogenic microorganisms which enter the tract [5]. The absence of this sterilizing action appears to have a more detrimental effect when the immune system is compromised and normal bacterial defense mechanisms are impaired. Proton pump inhibitors (PPIs) are the most commonly used drug for effective gastric acid suppression and play a major role in the treatment of diseases resulting from gastric acid oversecretion. It is necessary to determine the potential harm caused by the continuous inhibition of gastric acid in patients with cirrhosis and whether it increases their risk of contracting secondary diseases or infections
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