Proton Pump Inhibitors Increase Infections in Cirrhosis Patients

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RICHMOND, VA — The rate of serious infections is significantly increased for patients with decompensated cirrhosis who take proton pump inhibitors (PPI), according to a recent study.1

Researchers from McGuire Veterans Affairs Medical Center in Richmond, VA, sought to determine the extent to which PPIs increase the rate of infections among these patients.

In the retrospective study, investigators used Veterans Health Administration data to identify decompensated cirrhotic patients from 2001 to 2009. Some 1,268 new PPI users after decompensation were matched to those who did not initiate gastric acid suppression.

More than half of the patients with decompensated cirrhosis were new users of gastric acid suppressants, with 45.6% of them taking PPIs.

Patients who developed serious infections, defined as those requiring hospitalization, were separated into two groups: acid suppression-related (spontaneous bacterial peritonitis, bacteremia, Clostridium difficile and pneumonia) and non-acid suppression-related.

In the PPI propensity-matched analysis, 25.3% developed serious infections, and PPI users developed acid suppression-related serious infections at a rate 1.75 times faster than non-users (95% CI: 1.32–2.34).

Rates for H2 receptor antagonists were not found to be significantly significant.

“We conclude that veterans with decompensated cirrhosis who were started on PPI therapy after decompensation had a significantly higher risk of developing serious infections compared with those who were not initiated on gastric acid suppression,” the authors write. “This increase in risk occurs in a time-varying fashion and is not explained by confounding by concomitant drug use, comorbid conditions or age. As patients with decompensated cirrhosis remain at a high risk of serious infections, clinicians should re-evaluate the reason for prescribing PPI and, wherever possible, replace their acid suppressive needs with H2RAs.”

They called for further studies to prospectively analyze the value of PPI withdrawal in patients with decompensated cirrhosis.

1. Bajaj JS, Ratliff SM, Heuman DM, Lapane KL. Proton pump inhibitors are associated with a high rate of serious infections in veterans with decompensated cirrhosis. Aliment Pharmacol Ther. 2012 Sep 11. doi: 10.1111/apt.12045. [Epub ahead of print] PubMed PMID: 22966967.

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