Frequency of spontaneous bacterial peritonintis in chronic liver disease patients using proton pump inhibitors.
Objectives: To determine the frequency of spontaneous bacterial peritonitis (SBP) in chronic liver disease patients with ascites using proton pump inhibitors (PPI). Study Design: Prospective cohort study. Setting: Medicine Unit-II, Shalamar Hospital Lahore. Period: From 1st January to 30thJune 2017. Materials & Methods: A total of 380 patients enrolled in present study were divided into two groups; PPI group and non PPI group. Each group had 190 patients. We performed an extensive matching in both groups to minimize selection bias and SBP incidence was compared in both groups. Multivariate analysis was applied to sort out the causal relationship between PPI use and SBP. Results: Applying strict exclusion criteria, SBP incidence in chronic liver disease patients with ascites was found significantly high in PPI group than non-PPI group (12.63% vs. 6.84%, P Value 0.002). Moreover, a large no of patients (39.47%) were using PPI for inappropriate indications while acid peptic disease was the most common indication for its use (60.53%). Conclusion: Use of proton pump inhibitors in chronic liver disease patients with ascites significantly increases the risk of spontaneous bacterial peritonitis.