title: Association between acid suppressive therapy and spontaneous bacterial peritonitis in cirrhotic patients with ascites.
abstract: OBJECTIVE
  Proton pump inhibitor (PPI) or histamine-2 receptor antagonist (H2RA) therapy may cause intestinal bacterial overgrowth and translocation. Therefore, acid suppressive therapy may increase the risk of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites.
  
  
  METHODS
  A total of 176 cirrhotic patients with ascites who underwent diagnostic paracentesis between September 2004 and April 2009 were included in the analysis. Patients with gastrointestinal hemorrhage and/or antibiotic therapy within 2 weeks prior to hospital admission were excluded. SBP was defined as ≥250/mm(3) polymorphonuclear white blood cells with or without a positive culture from the ascitic fluid. Eighty-three patients (mean age 56.1 years, 63 males) had SBP and 93 (mean age 54.7 years, 75 males) did not.
  
  
  RESULTS
  On the multivariate analysis, a Child-Pugh class C (OR = 2.890, 95% CI 1.443-5.786; p = 0.003), high MELD scores (≥ 20, OR = 3.540, 95% CI 1.155-10.849; p = 0.027), and PPI use (OR = 3.443, 95% CI 1.164-10.188; p = 0.025) were risk factors for SBP. H2RA was not associated with SBP.
  
  
  CONCLUSIONS
  PPI use, as well as Child-Pugh class C and high MELD scores, was an independent risk factor for the development of SBP in cirrhotic patients with ascites. Further prospective studies are warranted to clarify this issue.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Choi
authors.forename: Heon Ju
authors.initials: HJ
authors.lastname: Lee
authors.forename: Kyeong Ok
authors.initials: KO
authors.lastname: Kim
authors.forename: Si Hyung
authors.initials: SH
authors.lastname: Lee
authors.forename: Jong Ryul
authors.initials: JR
authors.lastname: Eun
authors.forename: Byung Ik
authors.initials: BI
authors.lastname: Jang
authors.forename: Tae Nyeun
authors.initials: TN
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000382:microbiology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology; D006635:Histamine H2 Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008103:Liver Cirrhosis; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000453:epidemiology* / Q000382:microbiology; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors