Proton Pump Inhibitor Therapy Does Not Increase theIncidence of Bacterial Infection in Decompensated CirrhoticPatients

TERG, R; CASCIATO P; GARBE C; CARTIER M; STIEBEN T; MENDIZABAL M; NIVEYRO C; BENAVIDEZ J; MARINO M; COLOMBATO L; BERBARA D; SILVA M; BARREYRO FJ; FASSIO E; GADANO A

Boston, USA

Congreso; The Liver Meeting 2012; 2012

American Association for the Study of Liver Diseases

ArgentinaBackground: Retrospective studies show an associationbetween proton pump inhibitor (PPI) therapy with spontaneousbacterial peritonitis (SBP). Objectives: To investigate the relationshipbetween PPI and bacterial infections in decompensatedcirrhotic patients in a large nationwide prospective study Methods:Seven hundred and seventy patients with diagnosis ofdecompensated cirrhosis admitted consecutively in 23 hospitalsin Argentina from March 2011 to April 2012 were carefullyinvestigated for PPI consumption in the previous 3 months. Intotal 251 patients were excluded due to active gastrointestinalhaemorrhage in 126 patient, antibiotics use in the previous 2weeks in 54 patients, HIV positive in 46 patients and immunosupressivetherapy in 25 patients. Results: Overall, 226 out of519 patients (43.5%) had had PPI therapy within the last 3months, most of which were still on PPI at admission. In 135patients PPI administration was longer than 2 weeks. Bacterialinfection was demonstrated in 255 patients (49.1%).Overall,384 patients had ascites at admission and SBP was diagnosedin 95 patients of them (24.7%).There was no significant differencein the rate of PPI consumption between infected versus noninfected patients (44.3% vs 42.8%) neither between SBPpatients versus patients with ascites without SBP (46.3% vs53.7%) . In 40 patients receiving PPI (39.2%) no clear indicationwas documented. Mortality was significantly higher ininfected compared to non infected patients (17.6% vs 10.2%)(p=0.01) Conclusion: In the current large multicenter, prospectivestudy, PPI therapy in cirrhotic patients was not associatedwith a higher risk of bacterial infections, including SBP.