title: Use of proton pump inhibitors decrease cellular oxidative burst in patients with decompensated cirrhosis.
abstract: OBJECTIVE
  Proton pump inhibitors (PPIs) are commonly used antisecretory drugs and have been linked to an increased risk of bacterial infections in cirrhosis. We investigated whether the treatment with PPIs in cirrhosis affects the oxidative burst activity of granulocytes and monocytes and its possible interference with serum norfloxacin (Nflx) levels in these patients.
  
  
  METHODS
  70 patients with cirrhosis and ascitic fluid and 24 healthy controls were included in the study and distributed into groups according to the regular use of PPIs and/or norfloxacin. The blood granulocyte and monocyte's phagocytic activity and oxidative burst were evaluated by flow cytometry. Blood levels of norfloxacin were measured by HPLC and bacterial translocation was evaluated by detection of bacterial DNA in blood.
  
  
  RESULTS
  Use of PPIs was associated with a decreased granulocyte and monocyte oxidative burst, but not of phagocytic activity, as compared with patients not receiving PPIs. PPIs use did not affect serum norfloxacin levels in patients. A not significant trend to an increased bacterial DNA translocation was observed in patients receiving PPIs, including patients simultaneously receiving norfloxacin.
  
  
  CONCLUSIONS
  PPIs significantly decrease cellular oxidative burst in cirrhosis. This fact may provide a pathogenic explanation to the reported high rates of bacterial infections in this setting, and strongly suggests that PPIs should only be used in patients with cirrhosis when clinically indicated.
authors.affiliation: CIBERehd Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Irma
authors.initials: I
authors.lastname: Garcia-Martinez
authors.forename: Rubén
authors.initials: R
authors.lastname: Francés
authors.forename: Pedro
authors.initials: P
authors.lastname: Zapater
authors.forename: Paula
authors.initials: P
authors.lastname: Giménez
authors.forename: Isabel
authors.initials: I
authors.lastname: Gómez-Hurtado
authors.forename: Alba
authors.initials: A
authors.lastname: Moratalla
authors.forename: Beatriz
authors.initials: B
authors.lastname: Lozano-Ruiz
authors.forename: Pablo
authors.initials: P
authors.lastname: Bellot
authors.forename: José M
authors.initials: JM
authors.lastname: González-Navajas
authors.forename: José
authors.initials: J
authors.lastname: Such
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000209:etiology; D018988:Bacterial Translocation / Q000187:drug effects; D003864:Depression, Chemical; D004347:Drug Interactions; D005260:Female; D006098:Granulocytes / Q000276:immunology / Q000378:metabolism; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology / Q000378:metabolism; D009643:Norfloxacin / Q000097:blood; D010587:Phagocytosis / Q000187:drug effects; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D016897:Respiratory Burst / Q000187:drug effects*
chemical_list: D054328:Proton Pump Inhibitors; D009643:Norfloxacin
keywords: bacterial DNA; cirrhosis; norfloxacin; oxidative burst; proton pump inhibitors