Alhumaid Saad, Al Mutair Abbas, Al Alawi Zainab, Zaidi Abdul Rehman Zia, Rabaan Ali A, Elhazmi Alyaa, Al-Omari Awad
Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, Saudi Arabia.
Research Center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia.
Gut Pathog. 2021 Mar 19;13(1):17. doi: 10.1186/s13099-021-00414-8.
Spontaneous bacterial peritonitis (SBP) is one of the most common infectious diseases in patients with cirrhosis and is associated with serious prognosis. A prevailing dogma posits that SBP is exacerbated by the frequent use of proton pump inhibitors (PPIs).
To re-assess the association between PPIs use and SBP incidence with larger and better-quality data.
The studies were identified by searching Proquest, Medline, and Embase for English language articles published between January 2008 and March 2020 using the following keywords alone or in combination: anti-ulcer agent, antacid, proton pump inhibitor, proton pumps, PPI, omeprazole, rabeprazole, lansoprazole, pantoprazole, esomeprazole, peritonitis, spontaneous bacterial peritonitis, SBP, ascites, cirrhosis, ascitic and cirrhotic. Three authors critically reviewed all of the studies retrieved and selected those judged to be the most relevant. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Sub-group analyses were done to decrease the heterogeneity.
A total of twenty-three studies: seven case-control, and sixteen cohorts, involving 10,386 patients were analyzed. The overall results showed a statistically significant association between SBP and PPIs use (pooled odds ratio (OR): 1.80, 95% CI of 1.41 to 2.31). Substantial heterogeneity was observed. On subgroup analysis involving cohort studies, the association was weaker (OR: 1.55 with 95% CI of 1.16 to 2.06 p < 0.00001) but still statistically significant and with high heterogeneity (Chip = 57.68; I = 74%). For case-control studies, the OR was 2.62 with a 95% CI of 1.94 to 3.54. The funnel plot was asymmetric and Egger's test confirmed asymmetry suggesting publication bias (intercept = - 0.05, SE = 0.27, P = 0.850 two-tailed).
This meta-analysis sheds light on the conflicting results raised by previous studies regarding the association of SBP with PPIs use. Our meta-analysis showed that there is a weak association, although statistically significant, between SBP and PPIs use. However, the magnitude of the possible association diminished when analysis focused on higher quality data that were more robust. Thus, this updated meta-analysis suggests judicious use of PPIs among cirrhotic patients with ascites.
自发性细菌性腹膜炎（SBP）是肝硬化患者中最常见的传染病之一，且与严重的预后相关。一种普遍的观点认为，频繁使用质子泵抑制剂（PPI）会加重SBP。
利用更大规模、质量更高的数据重新评估PPI使用与SBP发病率之间的关联。
通过在Proquest、Medline和Embase数据库中检索2008年1月至2020年3月发表的英文文章来确定研究，使用以下关键词单独或组合检索：抗溃疡药、抗酸剂、质子泵抑制剂、质子泵、PPI、奥美拉唑、雷贝拉唑、兰索拉唑、泮托拉唑、埃索美拉唑、腹膜炎、自发性细菌性腹膜炎、SBP、腹水、肝硬化、腹水和肝硬化。三位作者对所有检索到的研究进行了严格审查，并选择了那些被认为最相关的研究。遵循系统评价和Meta分析的首选报告项目（PRISMA）声明。计算合并比值比（OR）及95%置信区间（CI）。进行亚组分析以减少异质性。
共分析了23项研究，其中7项病例对照研究和16项队列研究，涉及10386例患者。总体结果显示SBP与PPI使用之间存在统计学显著关联（合并比值比（OR）：1.80，95%CI为1.41至2.31）。观察到显著的异质性。在涉及队列研究的亚组分析中，关联较弱（OR：1.55，95%CI为1.16至2.06，p<0.00001），但仍具有统计学显著性且异质性高（卡方=57.68；I=74%）。对于病例对照研究，OR为2.62，95%CI为1.94至3.54。漏斗图不对称，Egger检验证实了不对称性，提示存在发表偏倚（截距=-0.05，标准误=0.27，P=0.850，双侧）。
这项Meta分析揭示了先前研究中关于SBP与PPI使用关联的相互矛盾的结果。我们的Meta分析表明，SBP与PPI使用之间存在弱关联，尽管具有统计学显著性。然而，当分析集中在质量更高、更可靠的数据时，可能关联的程度有所降低。因此，这项更新的Meta分析建议在有腹水的肝硬化患者中谨慎使用PPI。
