Proton pump inhibitors and H2receptor antagonists (PPI/H2RA) are frequently prescribed in hospitalized patients with cirrhosis. There are conflicting reports regarding the risk of spontaneous bacterial peritonitis (SBP) in hospitalized patients with cirrhosis using acidsuppressive therapy. We performed a metaanalysis to evaluate the association between acidsuppressive therapy and the risk of SBP.
We searched MEDLINE and 4 other databases for subject headings and text words related to SBP and acidsuppressive 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 randomeffects model and odds ratios (ORs) were calculated.
Five casecontrol studies met the inclusion criteria (n=965). Acidsuppressive therapy increased risk for SBP. There was an increased risk of developing SBP for patients using PPI therapy (OR 2.76, 95% CI 1.81 4.21) compared to those using H2RA therapy (OR 1.56, 95% CI 0.91 2.68). There was very little heterogeneity among the included studies.
Pharmacologic acid suppression was associated with 23 times greater risk of SBP in patients with cirrhosis. Because of the observational nature of the analyzed studies,it is not possible to determine the cause of this association. Further studies are required to determine the mechanisms by which acidsuppressive therapy increases the risk for SBP in patients with cirrhosis.
To cite this abstract:Deshpande A, Hernandez A, Pant C, Thota P, Hassan S, Mapara S, Pasupuleti V. Pharmacologic Acid Suppression Is Associated with Spontaneous Bacterial Peritonitis in Patients with Cirrhosis: A Metaanalysis. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97619. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/pharmacologic-acid-suppression-is-associated-with-spontaneous-bacterial-peritonitis-in-patients-with-cirrhosis-a-metaanalysis/. Accessed April 7, 2020.