Background/Aims: Proton pump inhibitor (PPI) is common used in patients with cirrhosis. However, it remains controversial whether PPI use is related to spontaneous bacterial peritonitis (SBP). Since growing literatures of different results have been published, we performed an updated meta-analysis to evaluate the association between PPI use and SBP. Moreover, potential influences of characteristic including study design, patient ethnicity, and definition of PPI use on the outcome of the meta-analysis were also evaluated.
Materials and Methods: Relevant studies were obtained via systematic search of PubMed and Embase databases. A random-effect model was applied to combine the data. Subgroup analysis was conducted to seek the source of heterogeneity.
Results: 23 studies with 99,608 cirrhotic patients were enrolled. Overall, PPI use was significantly associated with SBP in cirrhotic patients (risk ratio [RR]: 1.79, p<0.001). Subgroup analyses showed that PPI use was associated with SBP in retrospective case-controls studies (RR: 2.12, p<0.001) and retrospective cohort studies (RR: 1.68, p<0.001), but not in prospective cohort studies (RR: 1.22, p=0.22). Results also showed that PPI use was consistently associated with SBP among Caucasians (RR: 1.50, p<0.001) and among Asians (RR: 1.95, p<0.001). Moreover, both PPI use at the diagnosis of SBP and any PPI use within study periods were associated with SBP in cirrhotic patients.
Conclusion: PPI use may be related to SBP in cirrhotic patients, which is consistent among Caucasians and Asians. These results should be validated in large-scale prospective cohort studies.