RESUMO
BACKGROUND & AIM: Retrospective studies show an association between proton pump inhibitor (PPI) therapy and spontaneous bacterial peritonitis (SBP). We investigate the relationship between PPI and SBP in decompensated cirrhotic patients in a large nationwide prospective study. METHODS: Seven hundred seventy patients with a diagnosis of decompensated cirrhosis were admitted consecutively in 23 hospitals in Argentina from March 2011 to April 2012; the patients were carefully investigated for PPI consumption in the previous 3 months. In total, 251 patients were excluded because of active gastrointestinal hemorrhage, antibiotic use during the preceding weeks, HIV-positive status and immunosuppressive therapy. RESULTS: Two hundred twenty-six out of 519 patients (43.5%) had received PPI therapy within the last 3 months. In 135 patients, PPIs were administered for longer than 2 weeks. A bacterial infection was shown in 255 patients (49.1%). SBP was diagnosed in 95 patients out of 394 patients with ascites (24.7%). There was no significant difference in the rate of PPI consumption between the infected and the non-infected patients (44.3% vs. 42.8%) or between the SBP patients and the patients with ascites without SBP (46% vs. 42%). In the SBP patients, the duration of PPI administration did not influence the rate of SBP occurrence. The type of bacteria and the origin of SBP infection were similar in the patients with and without PPI. CONCLUSION: In the current large, multicenter, prospective study, PPI therapy, specifically evaluated at admission of consecutive cirrhotic patients, was not associated with a higher risk of SBP.
Assuntos
Infecções Bacterianas , Cirrose Hepática , Peritonite , Inibidores da Bomba de Prótons , Adulto , Idoso , Argentina/epidemiologia , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Infecções Bacterianas/terapia , Progressão da Doença , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/fisiopatologia , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Peritonite/diagnóstico , Peritonite/epidemiologia , Peritonite/etiologia , Peritonite/terapia , Estudos Prospectivos , Inibidores da Bomba de Prótons/administração & dosagem , Inibidores da Bomba de Prótons/efeitos adversos , Medição de Risco , Fatores de Risco , Estatística como AssuntoAssuntos
Antivirais/administração & dosagem , Hepatite B Crônica/tratamento farmacológico , Quimioterapia Combinada , Humanos , Interferon alfa-2 , Interferon-alfa/administração & dosagem , Polietilenoglicóis/administração & dosagem , RNA Viral/sangue , Proteínas Recombinantes , Ribavirina/administração & dosagem , Resultado do TratamentoRESUMO
El amplio uso de sutura contínua en la cirugía digestiva nos indujo a emplearla en la anastomosis del colédoco. Con la hipótesis de que esta técnica no provoca estenosis efectuamos un experimento sucesional provocado. Se operaron 21 perros practicándoseles una anastomosis coledociana con sutura contínua de polipropileno 6-0. Seguimiento P.O. con G.O.T.. G.P.T.. Fosfatasa alcalina y Bilirrubina. Se efectuó además estudio bactereológico en bilis para aerobios y anaerobios, colangiografía y anatomía patológica. Los animales se sacrificaron a 7, 25 y 150 días. A los 7 días se encontró importante proceso inflamatorio pericoledociano que provocó una estenosis anastomótica incompleta y pasajera, que se tradujo en "pequeño síndrome de hipertensión biliar". Las alteraciones retroceden encontrando a los 150 días valores de laboratorio y dimensiones del colédoco normales. Concluímos que la anastomosis del colédoco con sutura contínua es segura y que en este modelo experimental no provocó estenosis postoperatoria