Open AccessIncreased risk of biliary infection after biliary stent placement in users of proton pump inhibitors
Author(s) -
Hakuta Ryunosuke,
Nakai Yousuke,
Oyama Hiroki,
Noguchi Kensaku,
Kanai Sachiko,
Nomura Yusuke,
Suzuki Tatsunori,
Ishigaki Kazunaga,
Saito Kei,
Saito Tomotaka,
Hamada Tsuyoshi,
Takahara Naminatsu,
Mizuno Suguru,
Kogure Hirofumi,
Moriya Kyoji,
Fujishiro Mitsuhiro
Publication year - 2023
Publication title -
den open
Language(s) - English
Resource type - Journals
ISSN - 2692-4609
DOI - 10.1002/deo2.129
Subject(s) - endoscopic retrograde cholangiopancreatography , medicine , hazard ratio , biliary stent , incidence (geometry) , biliary drainage , gastroenterology , major duodenal papilla , proportional hazards model , stent , cumulative incidence , confidence interval , retrospective cohort study , cohort , physics , pancreatitis , optics
Objectives Proton pump inhibitors (PPIs) are widely prescribed medications for gastric acid‐induced diseases. Despite the effectiveness of PPIs, recent evidence suggested an increased risk of various bacterial infections in PPI users. The current study was conducted to evaluate the risk of biliary infection after endoscopic biliary stent placement in regular users of PPIs. Methods Consecutive patients with a native papilla who underwent endoscopic retrograde cholangiopancreatography and stent placement for biliary stricture between January 2010 and August 2019 were included in this retrospective study. The cumulative incidences of biliary infection were compared between regular and non‐regular PPI users. Results During the study period, 270 regular PPI users and 146 non‐regular PPI users were included in the analyses. Age, gender, and indication of endoscopic retrograde cholangiopancreatography were not different between the two groups. The incidences of biliary infection were 43% in regular PPI users and 36% in non‐regular PPI users but the time to biliary infection was significantly shorter in regular PPI users than in non‐regular users (28 vs. 87 days, p = 0.01). The cumulative incidence of biliary infection was significantly higher in regular PPI users compared with non‐regular users ( p = 0.008). The multivariable Cox regression analysis also showed a significantly higher hazard ratio of biliary infection in regular PPI users (1.62 [95% confidence interval 1.16–2.26; p = 0.005]). Conclusions Regular PPI use was associated with a higher risk of biliary infection after endoscopic biliary drainage. Inappropriate PPI use should be avoided.