IDDF2019-ABS-0306 Risk of spontaneous bacterial peritonitis with use of proton pump inhibitors – a systemic review and meta-analysis

Abstract

Background Spontaneous bacterial peritonitis (SBP) is a frequent complication seen among cirrhotic patients. The use of proton pump inhibitors (PPIs) has been suggested to be associated with a higher incidence of SBP. However, previous studies including case controls, cohorts, and meta-analyses provided conflicting conclusions. In light of newer studies that were done to re-evaluate the causality of PPI use and development of SBP, we aim to re-assess the association between PPI use and SBP incidence with larger and better quality data. Methods Databases of Medline, Cochrane, and Google Scholar were used to search for relevant articles. Two reviewers independently assessed the quality of each included study. Disagreements were resolved by the third author. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Sub-group analyses were done to decrease the heterogeneity. Results A total of twenty-one studies: ten case-control, ten cohorts, and one randomized controlled trial, involving 13,862 patients were analyzed. The overall results (figure 1) showed a statistically significant association between SBP and PPI use (pooled odds ratio (OR): 2.02, 95% CI of 1.51 to 2.69). Substantial heterogeneity was observed. On sub-group analysis involving cohort and randomized controlled trial, the association was weaker (OR: 1.36 with 95% CI of 1.17 to 1.57 p Conclusions This meta-analysis sheds light on the conflicting results raised by previous studies regarding the association of SBP with PPI use. The present meta-analysis showed that there is a weak association, although statistically significant, between SBP and PPI use. Thus, this updated meta-analysis suggests judicious use of PPI among cirrhotic patients with ascites.