title: Proton pump inhibitor therapy and its association with spontaneous bacterial peritonitis incidence and mortality: A meta-analysis.
abstract: BACKGROUND
  Previous meta-analyses reported proton pump inhibitor (PPI) therapy is associated with increased incidence of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. However, this conclusion was based on case-control studies. Moreover, the association between PPI use and mortality of SBP has not yet been confirmed.
  
  
  OBJECTIVE
  To evaluate the association between PPI use and SBP incidence and mortality using case-control and cohort studies.
  
  
  METHODS
  We searched Medline, Embase and Web of Knowledge for relevant articles published up to January 2015. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.
  
  
  RESULTS
  A total of 10 case-control and six cohort studies involving 8145 patients were analyzed. The overall analysis indicated that PPI use was associated with SBP (OR=2.11, 95% CI: 1.46-3.06). The association was limited in case-control studies (OR=2.97, 95% CI: 2.06-4.26) but not in cohort studies (OR=1.18, 95% CI: 0.99-1.14). PPI therapy was not associated with mortality during hospitalization or within 30 days after SBP (OR=1.54, 95% CI: 0.92-2.59).
  
  
  CONCLUSIONS
  We could not establish causality that PPI use increases the incidence or mortality of SBP.
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Yu
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Yurong
authors.initials: Y
authors.lastname: Tang
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Liuqin
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Yongping
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China.
authors.forename: Wenjie
authors.initials: W
authors.lastname: Xiong
authors.affiliation: Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China. Electronic address: linlin9100@aliyun.com.
authors.forename: Lin
authors.initials: L
authors.lastname: Lin
mesh_terms: D001424:Bacterial Infections / Q000401:mortality*; D016022:Case-Control Studies; D015331:Cohort Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications*; D016017:Odds Ratio; D010538:Peritonitis / Q000401:mortality*; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D054328:Proton Pump Inhibitors
keywords: Bacterial infections; Liver cirrhosis; Meta-analysis; Proton pump inhibitors