| Related Articles |
Proton Pump Inhibitor Use and Association with SpontaneousBacterial Peritonitis in Patients with Cirrhosis and Ascites (October).
Ann Pharmacother. 2012 Oct 2;
Authors: Siple JF, Morey JM, Gutman TE, Weinberg KL, Collins PD
Abstract
OBJECTIVE:To evaluate the literature regarding the efficacy and safety of proton pump inhibitors (PPIs) when they are used in patients with cirrhosis and ascites.DATA SOURCES:A literature search was conducted using MEDLINE (1966-May 2012) and Web of Science (1990-May 2012) with the terms proton pump inhibitor, antisecretory therapy, cirrhosis, ascites, spontaneous bacterial peritonitis, and Clostridium difficile. The search was restricted to articles published in English on the use of PPIs in humans. Reference citations from identified published articles were reviewed for relevant information.STUDY SELECTION AND DATA EXTRACTION:All articles in English identified from the DATA SOURCES: Cirrhosis may cause complications such as portal hypertension, esophageal varices, and ascites. Patients may be prescribed PPIs without clear indications or because of their propensity to develop upper gastro-intestinal symptoms and bleeding. However, gastric acidity is a major nonspecific defense mechanism and there is insufficient evidence on the need for chronic acid suppression in patients with cirrhosis. It is postulated that the portal hypertensive environment in cirrhosis and the acid suppression from PPIs can increase the risk of spontaneous bacterial patients with cirrhosis with ascites. Several retrospective studies and 1 meta-analysis peritonitis and C. difficile infection in patients with cirrhosis with ascites. Several retrospective studies and 1 meta-analysis have confirmed this association.CONCLUSIONS:Patients with cirrhosis and ascites should be monitored carefully while on PPIs for a possible increased risk of infection from spontaneous bacterial peritonitis and C. difficile. Prospective randomized trials are needed to confirm this association. Clinicians should be aware of this lesser known adverse effect of PPIs.
PMID: 23032651 [PubMed - as supplied by publisher]