Association between acid suppressive therapy and spontaneous bacterial peritonitis in cirrhotic patients with ascites

Objective. Proton pump inhibitor (PPI) or histamine-2 receptor antagonist (H2RA) therapy may cause intestinal bacterial overgrowth and translocation. Therefore, acid suppressive therapy may increase the risk of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites. Material and methods. A total of 176 cirrhotic patients with ascites who underwent diagnostic paracentesis between September 2004 and April 2009 were included in the analysis. Patients with gastrointestinal hemorrhage and/or antibiotic therapy within 2 weeks prior to hospital admission were excluded. SBP was defined as >= a parts per thousand yen250/mm<SU3</SU polymorphonuclear white blood cells with or without a positive culture from the ascitic fluid. Eighty-three patients (mean age 56.1 years, 63 males) had SBP and 93 (mean age 54.7 years, 75 males) did not. Results. On the multivariate analysis, a Child--Pugh class C (OR == 2.890, 95% CI 1.443--5.786; p == 0.003), high MELD scores (>= a parts per thousand yen20, OR == 3.540, 95% CI 1.155--10.849; p == 0.027), and PPI use (OR == 3.443, 95% CI 1.164--10.188; p == 0.025) were risk factors for SBP. H2RA was not associated with SBP. Conclusions. PPI use, as well as Child--Pugh class C and high MELD scores, was an independent risk factor for the development of SBP in cirrhotic patients with ascites. Further prospective studies are warranted to clarify this issue.