Acid suppression therapy and its association with spontaneous bacterial peritonitis incidence: A systemic review and meta‐analysis

摘要

Aim It is well known that the use of proton pump inhibitor (PPI) is widespread in patients with liver cirrhosis. PPI counteracts H 2 receptor inhibitor (H 2 RA) with its strong acid suppression effect. However, there is always a concern that PPI use may increase spontaneous bacteria peritonitis (SBP) development in cirrhotic patients. We aimed to investigate the association between acid suppression therapy (i.e. PPI or H 2 RA) and SBP through meta‐analysis. Methods We searched PubMed, Medline, Web of Science, Cochrane library, and Embase for relevant studies published up to April 2019. Pooled OR and 95% CI were calculated by a random‐effects model. Funnel plots and Egger's tests were performed for the evaluation of publication bias. Non‐parametric “trim‐and‐fill” tests were conducted for sensitivity analysis. Results A total of 20 original articles including 9566 cirrhotic patients were analyzed. The overall meta‐analysis highlighted that PPI use was associated with the risk of SBP (pooled OR 1.77, 95% CI 1.49–2.11). The conclusion was irrespective of study methods, whereas the result was inconsistent only in South America. However, the conclusion might not be stable enough and should be extrapolated with caution. Unlike PPI, we found H 2 RA was not associated with SBP (pooled OR 1.06, 95% CI 0.75–1.48). Conclusions In conclusion, PPI use, but not H 2 RA, will increase the incidence of SBP in cirrhotic patients. In addition, H 2 RA might be beneficial for patients who require long‐term acid suppression therapy.