title: Proton pump inhibitor therapy does not increase the incidence of spontaneous bacterial peritonitis in cirrhosis: a multicenter prospective study.
abstract: OBJECTIVE
  Retrospective studies show an association between proton pump inhibitor (PPI) therapy and spontaneous bacterial peritonitis (SBP). We investigate the relationship between PPI and SBP in decompensated cirrhotic patients in a large nationwide prospective study.
  
  
  METHODS
  Seven hundred seventy patients with a diagnosis of decompensated cirrhosis were admitted consecutively in 23 hospitals in Argentina from March 2011 to April 2012; the patients were carefully investigated for PPI consumption in the previous 3 months. In total, 251 patients were excluded because of active gastrointestinal hemorrhage, antibiotic use during the preceding weeks, HIV-positive status and immunosuppressive therapy.
  
  
  RESULTS
  Two hundred twenty-six out of 519 patients (43.5%) had received PPI therapy within the last 3 months. In 135 patients, PPIs were administered for longer than 2 weeks. A bacterial infection was shown in 255 patients (49.1%). SBP was diagnosed in 95 patients out of 394 patients with ascites (24.7%). There was no significant difference in the rate of PPI consumption between the infected and the non-infected patients (44.3% vs. 42.8%) or between the SBP patients and the patients with ascites without SBP (46% vs. 42%). In the SBP patients, the duration of PPI administration did not influence the rate of SBP occurrence. The type of bacteria and the origin of SBP infection were similar in the patients with and without PPI.
  
  
  CONCLUSIONS
  In the current large, multicenter, prospective study, PPI therapy, specifically evaluated at admission of consecutive cirrhotic patients, was not associated with a higher risk of SBP.
authors.affiliation: Hospital Bonorino Udaondo, Buenos Aires, Argentina.
authors.forename: Rubén
authors.initials: R
authors.lastname: Terg
authors.affiliation: Hospital Italiano, Buenos Aires, Argentina. Electronic address: paola.casciato@hospitalitaliano.org.ar.
authors.forename: Paola
authors.initials: P
authors.lastname: Casciato
authors.affiliation: Hospital Alejandro Posadas, Buenos Aires, Argentina.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Garbe
authors.affiliation: Hospital Bonorino Udaondo, Buenos Aires, Argentina.
authors.forename: Mariano
authors.initials: M
authors.lastname: Cartier
authors.affiliation: Hospital Madariaga, Entre Rios, Argentina.
authors.forename: Teodoro
authors.initials: T
authors.lastname: Stieben
authors.affiliation: Hospital Austral, Buenos Aires, Argentina.
authors.forename: Manuel
authors.initials: M
authors.lastname: Mendizabal
authors.affiliation: Hospital San Martin, Misiones, Argentina.
authors.forename: Carla
authors.initials: C
authors.lastname: Niveyro
authors.affiliation: Hospital Británico, Buenos Aires, Argentina.
authors.forename: Javier
authors.initials: J
authors.lastname: Benavides
authors.affiliation: Hospital Bonorino Udaondo, Buenos Aires, Argentina.
authors.forename: Mónica
authors.initials: M
authors.lastname: Marino
authors.affiliation: Hospital Británico, Buenos Aires, Argentina.
authors.forename: Luis
authors.initials: L
authors.lastname: Colombato
authors.affiliation: Hospital Madariaga, Entre Rios, Argentina.
authors.forename: Daniel
authors.initials: D
authors.lastname: Berbara
authors.affiliation: Hospital Británico, Buenos Aires, Argentina.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Silva
authors.affiliation: Hospital Bonorino Udaondo, Buenos Aires, Argentina.
authors.forename: Pablo
authors.initials: P
authors.lastname: Salgado
authors.affiliation: Hospital Británico, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Barreyro
authors.affiliation: Hospital Alejandro Posadas, Buenos Aires, Argentina.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Fassio
authors.affiliation: Hospital Italiano, Buenos Aires, Argentina.
authors.forename: Adrian
authors.initials: A
authors.lastname: Gadano
mesh_terms: D000328:Adult; D000368:Aged; D001118:Argentina / Q000453:epidemiology; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D008111:Liver Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D013223:Statistics as Topic
chemical_list: D054328:Proton Pump Inhibitors
keywords: Cirrhosis; Proton pump inhibitor; Spontaneous bacterial peritonitis