Hakuta Ryunosuke, Nakai Yousuke, Oyama Hiroki, Noguchi Kensaku, Kanai Sachiko, Nomura Yusuke, Suzuki Tatsunori, Ishigaki Kazunaga, Saito Kei, Saito Tomotaka, Hamada Tsuyoshi, Takahara Naminatsu, Mizuno Suguru, Kogure Hirofumi, Moriya Kyoji, Fujishiro Mitsuhiro
Department of Gastroenterology Graduate School of Medicine The University of Tokyo Tokyo Japan.
Department of Endoscopy and Endoscopic Surgery The University of Tokyo Tokyo Japan.
DEN Open. 2022 May 22;3(1):e129. doi: 10.1002/deo2.129. eCollection 2023 Apr.
Proton pump inhibitors (PPIs) are widely prescribed medications for gastric acid-induced diseases. Despite the effectiveness of PPIs, recent evidence suggested an increased risk of various bacterial infections in PPI users. The current study was conducted to evaluate the risk of biliary infection after endoscopic biliary stent placement in regular users of PPIs.
Consecutive patients with a native papilla who underwent endoscopic retrograde cholangiopancreatography and stent placement for biliary stricture between January 2010 and August 2019 were included in this retrospective study. The cumulative incidences of biliary infection were compared between regular and non-regular PPI users.
During the study period, 270 regular PPI users and 146 non-regular PPI users were included in the analyses. Age, gender, and indication of endoscopic retrograde cholangiopancreatography were not different between the two groups. The incidences of biliary infection were 43% in regular PPI users and 36% in non-regular PPI users but the time to biliary infection was significantly shorter in regular PPI users than in non-regular users (28 vs. 87 days, = 0.01). The cumulative incidence of biliary infection was significantly higher in regular PPI users compared with non-regular users ( = 0.008). The multivariable Cox regression analysis also showed a significantly higher hazard ratio of biliary infection in regular PPI users (1.62 [95% confidence interval 1.16-2.26; = 0.005]).
Regular PPI use was associated with a higher risk of biliary infection after endoscopic biliary drainage. Inappropriate PPI use should be avoided.
质子泵抑制剂（PPIs）是治疗胃酸相关疾病的常用处方药。尽管PPIs疗效显著，但近期证据表明，使用PPIs会增加各种细菌感染的风险。本研究旨在评估长期使用PPIs的患者在内镜下胆道支架置入术后发生胆道感染的风险。
本回顾性研究纳入了2010年1月至2019年8月间因胆道狭窄接受内镜逆行胰胆管造影及支架置入术的乳头正常的连续患者。比较长期和非长期使用PPIs患者的胆道感染累积发生率。
在研究期间，270名长期使用PPIs的患者和146名非长期使用PPIs的患者纳入分析。两组患者的年龄、性别和内镜逆行胰胆管造影的适应证无差异。长期使用PPIs的患者胆道感染发生率为43%，非长期使用PPIs的患者为36%，但长期使用PPIs的患者发生胆道感染的时间显著短于非长期使用者（28天对87天，P=0.01）。长期使用PPIs的患者胆道感染累积发生率显著高于非长期使用者（P=0.008）。多变量Cox回归分析也显示，长期使用PPIs的患者发生胆道感染的风险比显著更高（1.62[95%置信区间1.16-2.26；P=0.005]）。
长期使用PPIs与内镜下胆道引流术后胆道感染风险较高有关。应避免不恰当使用PPIs。
