Proton pump inhibitor therapy and its association with spontaneous bacterial peritonitis incidence and mortality: A meta-analysis

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. Aims: 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. (C) 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.