title: Proton pump inhibitor is a risk factor for recurrence of common bile duct stones after endoscopic sphincterotomy - propensity score matching analysis.
abstract: Background and study aimsRecurrence of common bile duct stones (CBDS) in patients treated with endoscopic sphincterotomy (ES) can lead to deterioration in their quality of life. Although the pathology and related factors are unclear, we speculated that proton pump inhibiter (PPI) administration increases the risk of CBDS recurrence by altering the bacterial mixture in the bile duct.Patients and methodsThe primary endpoint of this retrospective study was recurrence-free period. Several independent variables considered to have a relationship with CBDS recurrence including PPI use were analyzed using a COX proportional hazard model, with potential risk factors then evaluated by propensity score matching analysis.ResultsA total of 219 patients were analyzed, with CBDS recurrence found in 44. Analysis of variables using a COX proportional hazard model demonstrated that use of PPIs and ursodeoxycholic acid (UDCA), as well as the presence of periampullary diverticula (PD) each had a hazard ratio (HR) value greater than 1 (HR 2.2,P= 0.007; HR 2.0,P= 0.02; HR 1.9,P= 0.07; respectively). Furthermore, propensity score matching analysis revealed that the mean recurrence-free period in the oral PPI cohort was significantly shorter as compared with the non-PPI cohort (1613 vs. 2587 days,P= 0.014). In contrast, neither UDCA administration nor PD presence was found to be a significant factor in that analysis (1557 vs. 1654 days,P= 0.508; 1169 vs. 2011 days,P= 0.121; respectively).ConclusionOur results showed that oral PPI administration is a risk factor for CBDS recurrence in patients who undergo ES.
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Japan.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Fukuba
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Ishihara
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sonoyama
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Japan.
authors.forename: Noritsugu
authors.initials: N
authors.lastname: Yamashita
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Aimi
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Mishima
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Mishiro
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tobita
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Japan.
authors.forename: Koutarou
authors.initials: K
authors.lastname: Shibagaki
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Oshima
authors.affiliation: Division of Cancer Center, Shimane University Hospital, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Moriyama
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Japan.
authors.forename: Kousaku
authors.initials: K
authors.lastname: Kawashima
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Miyake
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Japan.
authors.forename: Norihisa
authors.initials: N
authors.lastname: Ishimura
authors.affiliation: Division of Gastrointestinal Endoscopy, Shimane University Hospital, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Internal Medicine II, Shimane University School of Medicine, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kinoshita