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Researchers find PPI use not associated with risk of SBP

In a prospective study, researchers in Argentina did not find an association between proton pump inhibitor therapy and a high risk for developing spontaneous bacterial peritonitis among patients with cirrhosis, according to published data.

“Recent retrospective studies show controversial results regarding an increased risk of spontaneous bacterial peritonitis in cirrhotic patients taking [proton pump inhibitors],” the researchers wrote. “Total [proton pump inhibitor] sales in Argentina represent approximately 169 million dollars annually and because [spontaneous bacterial peritonitis] represents one of the most frequent causes of bacterial infection in decompensated cirrhotic patients, the impact of the potential increase in [spontaneous bacterial peritonitis] in cirrhotic patients taking [proton pump inhibitors] should be urgently clarified.”

Researchers evaluated data of 770 patients with decompensated cirrhosis from 23 hospitals across Argentina between March 2011 and April 2012. The patients were monitored for PPI consumption over 3 months. Of these patients, 519 were included in the final analysis.

Overall, 43.5% of patients (n = 226) had received PPI therapy within the last 3 months. In 135 of patients, PPI therapy was administered for more than 2 weeks. Forty-nine percent of patients developed a bacterial infection (n = 255) and spontaneous bacterial peritonitis (SBP) was diagnosed in 95 patients out of 394 patients observed with ascites (24.7%).

The researchers did not find a significant difference in the rate of PPI consumption between the patients with an infection and those without (44.3% vs. 42.8%). In addition, no difference was observed between the patients who developed ascites compared with those who did not (46% vs. 42%).

Further analysis showed that the duration of PPI therapy did not have an effect on the rate of SBP occurrence, according to the research. The SBP rate in patients who received less than 2 weeks of PPI therapy was 26.6% compared with patients who underwent PPI therapy between 2 and 4 weeks (22.8%). Similarities between bacteria type and origin of SBP were nearly identical between the patients receiving and not receiving PPI.

“PPI use does not increase the risk of SBP,” the researchers concluded. “Future large prospective multicenter studies are needed to assess the role of PPI in the development of bacterial infection in cirrhosis.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.