Proton pump inhibitor use is associated with spontaneous bacterial peritonitis in patients with liver cirrhosis

Objective Accumulating evidence suggests that the use of proton pump inhibitors (PPIs) is associated with spontaneous bacterial peritonitis (SBP) in cirrhotic patients, although the results are inconsistent. We aimed to examine whether PPI use is associated with SBP in Japan, where the administration of PPIs is strictly regulated. Methods In this single-center retrospective study, we reviewed 65 patients with liver cirrhosis who were admitted between January 2008 and January 2013 due to ascites. The administration of any PPI for at least one week prior to admission was regarded as PPI use. Results Eighteen cirrhotic patients with SBP and 47 without SBP were identified. Both the serum bilirubin levels and international normalized ratio (INR) values were significantly elevated in the patients with SBP (p=0.007, 0.002). The model for end-stage liver disease scores (mean±SD) were 16.1±9.9 and 12.5±9.3 in those with and without SBP (p=0.009), respectively. PPIs were used in 16 out 18 in patients with SBP and 27 of 47 patients without SBP (p=0.002). A multivariate analysis identified INR (odds ratio (OR)=15.3, 95% CI 2.96-76.9, p=0.001) and PPI use (OR=6.41, 95% CI=1.16-35.7, p=0.033) to be independent risk factors for SBP. Conclusion The use of PPIs in cirrhotic patients with ascites is independently associated with SBP in the Japanese clinical setting.