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Subject Area

Family Medicine

Article Type

Original Study

Abstract

Objective The aim of this study was to assess the occurrence of spontaneous bacterial peritonitis in cirrhotic patients with ascites and is relationship to proton-pump inhibitor (PPI) use. Background Gastric acid plays an important role in resisting intestinal pathogens. Changes in gastric pH induced by antacids may damage the gastric protective barrier. Patients and methods This prospective cohort study was conducted on 100 patients of 18 years old or more, both sexes with liver cirrhosis and ascites. Patients were divided into two groups (50 patients in each); group (PPI use positive) with a history of PPIs use in the last 15 days at a dose of more than 20 mg and group (PPI use negative) without a history of PPI use. Results White blood cells in the blood and in the ascitic fluid showed significant increase in the PPI group than in the second group. Cultures of ascitic fluid were positive in 28 (56%) patients with PPI use, and 15 patients in the negative PPI use group and comparison showed significant increase in the positive PPI use group. The hazardous ratio of developing positive cultures in the PPI group is 1.687 times than the second group (95% confidence interval: 1.1–2.502). Conclusion The use of PPIs in cirrhotic patients who have ascites has a risk for developing spontaneous bacterial peritonitis; therefore, it is recommended to avoid their use in this category of patients.

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