title: Risk of spontaneous bacterial peritonitis associated with gastric Acid suppression.
abstract: The primary objective of this study was to determine the association between the use of gastric acid suppressants (GAS) and the risk of developing spontaneous bacterial peritonitis (SBP) in patients with advanced liver cirrhosis (LC). A case-control study nested within a cohort of 480,000 representatives of Taiwan National Health Insurance beneficiaries was carried out. A case was matched with 100 controls on age, gender, and index date of SBP diagnosis. GAS use was identified from the 1-year period before the index date. Conditional logistic regression analysis was used to adjust for various unbalanced covariates between users and nonusers of GAS. A total of 947 cases of SBP were identified among the 86,418 patients with advanced LC. A significant increased risk of developing SBP was found to be associated with current (within 30 days), and recent (within 30-90 day) use of 2 different classes of GAS: proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs). The confounder adjusted rate ratio (aRR) for the current use of PPIs was 2.77 (95% CI: 1.90-4.04) and H2RAs was 2.62 (95% CI: 2.00-3.42). The risk of SBP attenuated for the recent use of PPIs (aRR: 2.20, 95%CI: 1.60-3.02) or H2RAs (aRR: 1.72, 95% CI: 1.25-2.37). In addition, sensitivity analysis using hospitalized SBP as the primary outcome showed a similar risk for the current use of PPIs (aRR, 3.24; 95% CI: 2.08-5.05) and H2RAs (aRR 2.43; 95% CI 1.71-3.46). Furthermore, higher cumulative days of gastric acid suppression were associated with a higher risk of SBP (trend P < 0.0001). To conclude, exposure to GAS was associated with an increased risk of SBP in patients with advanced LC. The association was more pronounced in current PPI users compared with nonusers.
authors.affiliation: From the Department of Family Medicine, Chang Gung Memorial Hospital, Linkou, (S-SC, Y-CL, Y-WT); Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City (S-SC); Chang Gung University College of Medicine, Taoyuan City (S-SC, Y-CL, Y-WT); Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying Dis., Tainan City (C-CLai); Department of Emergency Medicine, National Taiwan University Hospital, Taipei City (M-tGL, W-TH, C-CLee); and Department of Emergency Medicine and General Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan (R.O.C.) (C-CLee).
authors.forename: Shy-Shin
authors.initials: SS
authors.lastname: Chang
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Lai
authors.forename: Meng-Tse Gabriel
authors.initials: MG
authors.lastname: Lee
authors.forename: Yu-Chien
authors.initials: YC
authors.lastname: Lee
authors.forename: Yi-Wen
authors.initials: YW
authors.lastname: Tsai
authors.forename: Wan-Ting
authors.initials: WT
authors.lastname: Hsu
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000863:Antacids / Q000627:therapeutic use; D001424:Bacterial Infections / Q000453:epidemiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005744:Gastric Acid; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000453:epidemiology*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000863:Antacids; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors