Seong Jun Hwang1, Dong Hyeon Lee2, Seong-Joon Koh2, Ji Won Kim2, Hyun Sun Park3, Byeong Gwan Kim2, Kook Lae Lee2. 1. Department of Internal Medicine, Asan Medical Center, Seoul, South Korea. 2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. 3. Laboratory of Intestinal Mucosa and Skin Immunology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
Abstract
BACKGROUND: Many studies and meta-analyses have investigated the associations among proton pump inhibitors (PPIs), spontaneous bacterial peritonitis (SBP), portosystemic encephalopathy (PSE), and other infections. However, these studies had limitations, including the omission of several relevant studies and drawing conclusions, based on the abstracts without consulting the full-text of the articles. To evaluate the association between PPIs and complications arising from cirrhosis and risks of PPI use in patients with cirrhosis. METHODS: Data were extracted from the EMBASE, PubMed, Cochrane, and Google Scholar databases. The Newcastle-Ottawa scale was used to assess the quality of the selected studies. RESULTS: A total of 29 studies (13 case-control and 16 cohort studies) involving 20,484 patients were included in the meta-analysis. The total relative risk (RR) for the 23 studies which investigated SBP was 1.31, and the 95% CI was 1.10-1.55 (I2 = 73.0%). The total RR for the 7 studies which examined PSE was 1.25 (95% CI 0.85-1.84, I2 = 96.1%). For the 7 studies which analyzed overall infection, the total RR was 1.37 (95% CI 1.07-1.76, I2 = 79.3%). The RR for the 2 cohort studies that assessed mortality was 1.39 (95% CI 0.85-2.27, I2 = 0.0%). CONCLUSION: PPI use in cirrhosis patients increased the SBP and overall infection risk. PPIs should be considered with appropriate indications when the benefits exceed the risks in cirrhosis patients with ascites.
BACKGROUND: Many studies and meta-analyses have investigated the associations among proton pump inhibitors (PPIs), spontaneous bacterial peritonitis (SBP), portosystemic encephalopathy (PSE), and other infections. However, these studies had limitations, including the omission of several relevant studies and drawing conclusions, based on the abstracts without consulting the full-text of the articles. To evaluate the association between PPIs and complications arising from cirrhosis and risks of PPI use in patients with cirrhosis. METHODS: Data were extracted from the EMBASE, PubMed, Cochrane, and Google Scholar databases. The Newcastle-Ottawa scale was used to assess the quality of the selected studies. RESULTS: A total of 29 studies (13 case-control and 16 cohort studies) involving 20,484 patients were included in the meta-analysis. The total relative risk (RR) for the 23 studies which investigated SBP was 1.31, and the 95% CI was 1.10-1.55 (I2 = 73.0%). The total RR for the 7 studies which examined PSE was 1.25 (95% CI 0.85-1.84, I2 = 96.1%). For the 7 studies which analyzed overall infection, the total RR was 1.37 (95% CI 1.07-1.76, I2 = 79.3%). The RR for the 2 cohort studies that assessed mortality was 1.39 (95% CI 0.85-2.27, I2 = 0.0%). CONCLUSION: PPI use in cirrhosis patients increased the SBP and overall infection risk. PPIs should be considered with appropriate indications when the benefits exceed the risks in cirrhosis patients with ascites.
Authors: Gati A Goel; Abhishek Deshpande; Rocio Lopez; Geraldine S Hall; David van Duin; William D Carey Journal: Clin Gastroenterol Hepatol Date: 2011-12-07 Impact factor: 11.382
Authors: Tammo L Tergast; Anika Wranke; Hans Laser; Svetlana Gerbel; Michael P Manns; Markus Cornberg; Benjamin Maasoumy Journal: Liver Int Date: 2018-05-07 Impact factor: 5.828
Authors: Anca Trifan; Carol Stanciu; Irina Girleanu; Oana Cristina Stoica; Ana Maria Singeap; Roxana Maxim; Stefan Andrei Chiriac; Alin Ciobica; Lucian Boiculese Journal: World J Gastroenterol Date: 2017-09-21 Impact factor: 5.742