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Acid‐suppressive therapy is associated with spontaneous bacterial peritonitis in cirrhotic patients: A meta‐analysis
Author(s) -
Deshpande Abhishek,
Pasupuleti Vinay,
Thota Priyaleela,
Pant Chaitanya,
Mapara Sulaiman,
Hassan Sohaib,
Rolston David D K,
Sferra Thomas J,
Hernandez Adrian V
Publication year - 2013
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12065
Subject(s) - medicine , spontaneous bacterial peritonitis , cirrhosis , odds ratio , confidence interval , gastroenterology , relative risk , prospective cohort study , meta analysis
Background and Aim Proton pump inhibitors ( PPI ) and H 2 ‐receptor antagonists (H2RA) are frequently prescribed in hospitalized patients with cirrhosis. There are conflicting reports regarding the role of acid‐suppressive therapy in predisposing hospitalized patients with cirrhosis to spontaneous bacterial peritonitis ( SBP ). The aim of this meta‐analysis was to evaluate the association between acid‐suppressive therapy and the risk of SBP in hospitalized patients with cirrhosis. Methods We searched MEDLINE and four other databases for subject headings and text words related to SBP and acid‐suppressive therapy. All observational studies that investigated the risk of SBP associated with PPI / H2RA therapy and utilized SBP as an endpoint were considered eligible. Data from the identified studies were combined by means of a random‐effects model and odds ratios ( OR s) were calculated. Results Eight studies ( n = 3815 patients) met inclusion criteria. The risk of hospitalized cirrhotic patients developing SBP increased when using acid‐suppressive therapy. The risk was greater with PPI therapy ( n = 3815; OR 3.15, 95% confidence interval 2.09–4.74) as compared to those on H2RA therapy ( n = 562; OR 1.71, 95% confidence interval 0.97–3.01). Conclusions Pharmacologic acid suppression was associated with a greater risk of SBP in hospitalized patients with cirrhosis. Cirrhotic patients receiving a PPI have approximately three times the risk of developing SBP compared with those not receiving this medication. Prospective studies may help clarify this relationship and shed light on the mechanism(s) by which acid‐suppressive therapy increases the risk of SBP in hospitalized patients with cirrhosis.