Association of gastric acid suppressants with the development of spontaneous bacterial peritonitis in cirrhotic patients with ascites

The study aimed to characterize the association of gastric acid suppressants (GAS) with the development of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites. A retrospective case controlled study from January 2013 to December 2017 at Cheng-Ching General Hospital was conducted. We included patients with a diagnosis of liver cirrhosis with ascites, divided into those with and without SBP. SBP was defined by ascitic fluid polymorphonuclear cell level. GAS users were patients who received GAS daily for more than 7 days in the 90 days before admission. Of 229 cirrhotic patients enrolled, 60 had SBP and 169 did not. The groups differed significantly in albumin (P = .045) and total bilirubin (P = .016) levels; in international normalized ratio (P = .007) and proton pump inhibitor (PPI) use (P = .021); but not in histamine-2 receptor antagonist (H(2)RA) use. Multivariate analysis identified PPI use as the only independent risk factor for SBP development (odds ratio 2.101, 95% confidence interval 1.122-3.935, P = .02). PPIs but not H2RAs may increase the incidence of SBP in cirrhotic patients with ascites. Prescribing PPIs in cirrhotic patients should be done carefully, for the minimal effective treatment duration.