Determining the Risk of Spontaneous Bacterial Peritonitis due to increase use of Proton Pump Inhibitors among cirrhotic patients with ascites.

Bashir Ahmed Shaikh,Aneel Kumar,Zahid Ali Shaikh,Aftab Hussain Shah

doi:10.12669/pjms.37.4.3476

Abstract

Objectives:The current study aimed to determine the Spontaneous Bacterial Peritonitis (SBP) risk due to increased use of Proton Pump Inhibitors (PPIs) among cirrhotic patients with ascites.Methods:This retrospective case-control study was conducted at Chandka Medical College & Hospital, Larkana from March 2013 to February 2014, involving 215 cirrhotic patients with ascites. Paracentesis was performed to distinguish cirrhotic patients with SBP and Polymorphonuclear Neutrophil (PMN) count ≥ 250 neutrophils/mm3 (cases) and non-SBP with PMN count < 250 neutrophils/mm3 (controls). The demographic details, history of PPIs use before admission and duration of Chronic Liver Disease (CLD) were inquired and statistical analysis was carried through SPSS Version 23.0.Results:Increased pre-hospital PPI intake was observed among cirrhotic patients with SBP (69.8%) as compared to those without SBP (48.8%; p = 0.014). The mean duration of PPI use was 19.16 ± 4.772 days, and it was more significant among older cirrhotic patients (p < 0.05). Increased duration of CLD was observed among PPI users, i.e. 20.47 ± 6.305 months vs. 18.95 ± 5.527 months among non-PPI users (p < 0.05).Conclusions:Our results show that cirrhotic patients with ascites consuming PPIs are more likely to develop SBP as compared to non-PPI users.

Highlights

Cirrhosis is a well-known late-stage liver disease characterized by inflammation, cell scarring and death, increasing the risk of bacterial infections
The Pump Inhibitors (PPIs) users and non-users were identified through interviews, and those consuming PPIs daily for the last two weeks were considered as PPI users
A total of 215 cirrhotic patients with ascites were enrolled in the study, and Spontaneous Bacterial Peritonitis (SBP) was confirmed among 43 patients while 172 non-SBP patients were placed in the control group, as shown in Table-I

Summary

Introduction

Cirrhosis is a well-known late-stage liver disease characterized by inflammation, cell scarring and death, increasing the risk of bacterial infections. It is associated with increased morbidity and mortality rate.[1] There is a four-fold increase in the complexity and mortality rate with bacterial infections among cirrhotic patients,[2] SBP has been documented as the most common and serious deadly complication observed among the cirrhotic patients with ascites.[3] The pathogenetic pathway of SBP indicates that it is triggered by the translocation of the bacteria from the gut flora to mesenteric lymph nodes, facilitated by the increased permeability of the gut and the overgrowth of the intestinal bacteria.[3]. It has been effective in controlling acid associated problems, but its overuse is well-documented among cirrhotic patients,[7] precipitating the enteric infection risk.[8]

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