Impact of long-term gastric acid suppression on spontaneous bacterial peritonitis in patients with advanced decompensated liver cirrhosis

Kuang Wei Huang, Yi-Chun Kuan, Jiing Chyuan Luo, Cheng Li Lin, Ji An Liang, Chia Hung Kao

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective Recent studies have presented conflicting results on the association between gastric acid suppression and spontaneous bacterial peritonitis (SBP). The long-term effects of gastric acid suppression on SBP in cirrhotic patients remain unclear. This study evaluated the risk of SBP in advanced decompensated cirrhotic patients with long-term gastric acid suppression. Methods Using the Taiwan National Health Insurance Research Database, we identified 4788 patients with decompensated cirrhosis from 1998 to 2011. The SBP incidence rate was compared among proton pump inhibitor (PPI), H2-receptor antagonist (H2RA), and control cohorts. Multivariate Cox proportional hazards regressions analysis was conducted to confirm the association between gastric acid suppression and SBP. Results Totally, 4788 patients were analyzed: 1870 in the PPI cohort, 1728 in the H2RA cohort, and 1190 in the control cohort. The overall incidences of SBP were 16.8, 11.9, and 9.80 per 1000 person-years in the PPI, H2RA, and control cohorts, respectively. The adjusted hazard ratio (aHR) of SBP during the follow-up period was 1.16- (95% confidence interval [CI], 0.72-1.86) and 1.00-fold (95% CI, 0.63-1.57) higher in the PPI and H2RA cohorts, respectively, than in the control cohort; the result was non-significant. Compared with the control cohort, patients with > 180 days of PPI therapy had significantly higher risks of SBP, with an aHR of 2.28 (95% CI, 1.37-3.78). Conclusions Long-term PPI use is associated with a high risk of SBP in advanced decompensated cirrhotic patients. Well-designed prospective studies are necessary to evaluate the safety of long-term PPI use in such patients.

Original languageEnglish
Pages (from-to)91-95
Number of pages5
JournalEuropean Journal of Internal Medicine
Volume32
DOIs
Publication statusPublished - Jul 1 2016

Fingerprint

Gastric Acid
Peritonitis
Liver Cirrhosis
Proton Pump Inhibitors
Histamine H2 Receptors
Confidence Intervals
Incidence
National Health Programs
Taiwan
Fibrosis
Regression Analysis
Databases
Prospective Studies
Safety

Keywords

  • Cirrhotic
  • Gastric acid suppression
  • National Health Insurance Research Database
  • Proton pump inhibitor (PPI)
  • Spontaneous bacterial peritonitis

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

Cite this

Impact of long-term gastric acid suppression on spontaneous bacterial peritonitis in patients with advanced decompensated liver cirrhosis. / Huang, Kuang Wei; Kuan, Yi-Chun; Luo, Jiing Chyuan; Lin, Cheng Li; Liang, Ji An; Kao, Chia Hung.

In: European Journal of Internal Medicine, Vol. 32, 01.07.2016, p. 91-95.

Research output: Contribution to journalArticle

@article{feeae7bbe0ad4eeeb645c1da5ee6902e,
title = "Impact of long-term gastric acid suppression on spontaneous bacterial peritonitis in patients with advanced decompensated liver cirrhosis",
abstract = "Objective Recent studies have presented conflicting results on the association between gastric acid suppression and spontaneous bacterial peritonitis (SBP). The long-term effects of gastric acid suppression on SBP in cirrhotic patients remain unclear. This study evaluated the risk of SBP in advanced decompensated cirrhotic patients with long-term gastric acid suppression. Methods Using the Taiwan National Health Insurance Research Database, we identified 4788 patients with decompensated cirrhosis from 1998 to 2011. The SBP incidence rate was compared among proton pump inhibitor (PPI), H2-receptor antagonist (H2RA), and control cohorts. Multivariate Cox proportional hazards regressions analysis was conducted to confirm the association between gastric acid suppression and SBP. Results Totally, 4788 patients were analyzed: 1870 in the PPI cohort, 1728 in the H2RA cohort, and 1190 in the control cohort. The overall incidences of SBP were 16.8, 11.9, and 9.80 per 1000 person-years in the PPI, H2RA, and control cohorts, respectively. The adjusted hazard ratio (aHR) of SBP during the follow-up period was 1.16- (95{\%} confidence interval [CI], 0.72-1.86) and 1.00-fold (95{\%} CI, 0.63-1.57) higher in the PPI and H2RA cohorts, respectively, than in the control cohort; the result was non-significant. Compared with the control cohort, patients with > 180 days of PPI therapy had significantly higher risks of SBP, with an aHR of 2.28 (95{\%} CI, 1.37-3.78). Conclusions Long-term PPI use is associated with a high risk of SBP in advanced decompensated cirrhotic patients. Well-designed prospective studies are necessary to evaluate the safety of long-term PPI use in such patients.",
keywords = "Cirrhotic, Gastric acid suppression, National Health Insurance Research Database, Proton pump inhibitor (PPI), Spontaneous bacterial peritonitis",
author = "Huang, {Kuang Wei} and Yi-Chun Kuan and Luo, {Jiing Chyuan} and Lin, {Cheng Li} and Liang, {Ji An} and Kao, {Chia Hung}",
year = "2016",
month = "7",
day = "1",
doi = "10.1016/j.ejim.2016.04.016",
language = "English",
volume = "32",
pages = "91--95",
journal = "European Journal of Internal Medicine",
issn = "0953-6205",
publisher = "Elsevier",

}

TY - JOUR

T1 - Impact of long-term gastric acid suppression on spontaneous bacterial peritonitis in patients with advanced decompensated liver cirrhosis

AU - Huang, Kuang Wei

AU - Kuan, Yi-Chun

AU - Luo, Jiing Chyuan

AU - Lin, Cheng Li

AU - Liang, Ji An

AU - Kao, Chia Hung

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Objective Recent studies have presented conflicting results on the association between gastric acid suppression and spontaneous bacterial peritonitis (SBP). The long-term effects of gastric acid suppression on SBP in cirrhotic patients remain unclear. This study evaluated the risk of SBP in advanced decompensated cirrhotic patients with long-term gastric acid suppression. Methods Using the Taiwan National Health Insurance Research Database, we identified 4788 patients with decompensated cirrhosis from 1998 to 2011. The SBP incidence rate was compared among proton pump inhibitor (PPI), H2-receptor antagonist (H2RA), and control cohorts. Multivariate Cox proportional hazards regressions analysis was conducted to confirm the association between gastric acid suppression and SBP. Results Totally, 4788 patients were analyzed: 1870 in the PPI cohort, 1728 in the H2RA cohort, and 1190 in the control cohort. The overall incidences of SBP were 16.8, 11.9, and 9.80 per 1000 person-years in the PPI, H2RA, and control cohorts, respectively. The adjusted hazard ratio (aHR) of SBP during the follow-up period was 1.16- (95% confidence interval [CI], 0.72-1.86) and 1.00-fold (95% CI, 0.63-1.57) higher in the PPI and H2RA cohorts, respectively, than in the control cohort; the result was non-significant. Compared with the control cohort, patients with > 180 days of PPI therapy had significantly higher risks of SBP, with an aHR of 2.28 (95% CI, 1.37-3.78). Conclusions Long-term PPI use is associated with a high risk of SBP in advanced decompensated cirrhotic patients. Well-designed prospective studies are necessary to evaluate the safety of long-term PPI use in such patients.

AB - Objective Recent studies have presented conflicting results on the association between gastric acid suppression and spontaneous bacterial peritonitis (SBP). The long-term effects of gastric acid suppression on SBP in cirrhotic patients remain unclear. This study evaluated the risk of SBP in advanced decompensated cirrhotic patients with long-term gastric acid suppression. Methods Using the Taiwan National Health Insurance Research Database, we identified 4788 patients with decompensated cirrhosis from 1998 to 2011. The SBP incidence rate was compared among proton pump inhibitor (PPI), H2-receptor antagonist (H2RA), and control cohorts. Multivariate Cox proportional hazards regressions analysis was conducted to confirm the association between gastric acid suppression and SBP. Results Totally, 4788 patients were analyzed: 1870 in the PPI cohort, 1728 in the H2RA cohort, and 1190 in the control cohort. The overall incidences of SBP were 16.8, 11.9, and 9.80 per 1000 person-years in the PPI, H2RA, and control cohorts, respectively. The adjusted hazard ratio (aHR) of SBP during the follow-up period was 1.16- (95% confidence interval [CI], 0.72-1.86) and 1.00-fold (95% CI, 0.63-1.57) higher in the PPI and H2RA cohorts, respectively, than in the control cohort; the result was non-significant. Compared with the control cohort, patients with > 180 days of PPI therapy had significantly higher risks of SBP, with an aHR of 2.28 (95% CI, 1.37-3.78). Conclusions Long-term PPI use is associated with a high risk of SBP in advanced decompensated cirrhotic patients. Well-designed prospective studies are necessary to evaluate the safety of long-term PPI use in such patients.

KW - Cirrhotic

KW - Gastric acid suppression

KW - National Health Insurance Research Database

KW - Proton pump inhibitor (PPI)

KW - Spontaneous bacterial peritonitis

UR - http://www.scopus.com/inward/record.url?scp=84964617593&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84964617593&partnerID=8YFLogxK

U2 - 10.1016/j.ejim.2016.04.016

DO - 10.1016/j.ejim.2016.04.016

M3 - Article

AN - SCOPUS:84964617593

VL - 32

SP - 91

EP - 95

JO - European Journal of Internal Medicine

JF - European Journal of Internal Medicine

SN - 0953-6205

ER -