The association between pre hospital use of proton pump inhibitors and spontaneous bacterial peritonitis in patients presenting with liver cirrhosis.

Abstract

Objectives: To determine the association between pre hospital use of proton pump inhibitors and spontaneous bacterial peritonitis in patients presenting with liver cirrhosis. Study Design: Case control study.  Setting: Department of Gastroenterology at Liaquat National Hospital Karachi. Period: Six months (From 1st – March-2017 to 31st – August-2017). Material and Methods: There were 120 patients with cirrhosis were included in this study. Sixty patients were cases with spontaneous bacterial peritonitis (SBP) and 60 patients were control without spontaneous bacterial peritonitis. All patients were interviewed for pre hospital intake of PPI (as per operational definition). All the data was entered on predesigned proforma (attached). Results: The average age of the patients was 42.47±9.87 years. Rate of PPI use was significantly higher among cases with SBP (46.7%) as compared to the patients without SBP (23.3%). Conclusion: In conclusion, PPI use (acid suppression) was associated with the development of SBP in cirrhotic patients with ascites.  We recommend that PPI indications in cirrhotic patients should be frequently re-evaluated with particular attention devoted to duration of use, especially following endoscopic variceal ligation (EVL).