Retrospective Study
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World J Gastroenterol. Jul 7, 2014; 20(25): 8187-8194
Published online Jul 7, 2014. doi: 10.3748/wjg.v20.i25.8187
Effect of gastric acid suppressants and prokinetics on peritoneal dialysis-related peritonitis
Ji Eun Kwon, Seong-Joon Koh, Jaeyoung Chun, Ji Won Kim, Byeong Gwan Kim, Kook Lae Lee, Jong Pil Im, Joo Sung Kim, Hyun Chae Jung
Ji Eun Kwon, Jaeyoung Chun, Jong Pil Im, Joo Sung Kim, Hyun Chae Jung, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 110-799, South Korea
Seong-Joon Koh, Ji Won Kim, Byeong Gwan Kim, Kook Lae Lee, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul 156-707, South Korea
Author contributions: Kwon JE and Koh SJ contributed equally to this article; Kwon JE, Koh SJ and Kim BG designed the research; Kwon JE, Chun J and Im JP collected sample and interpreted data; Koh SJ, Kim JW, Lee KL, Kim JS and Jung HC contributed statistical analysis and interpretation of data; Kwon JE, Koh SJ and Kim BG wrote the paper.
Correspondence to: Byeong Gwan Kim, MD, PhD, Professor of Internal Medicine, Department of Internal Medicine, Seoul National University Boramae Hospital, 5 Gil 20, Boramae-Road, Dongjak-Gu, Seoul 156-707, South Korea. caskim@brm.co.kr
Telephone: +82-2-8702234 Fax: +82-2-8703863
Received: January 20, 2014
Revised: March 18, 2014
Accepted: April 15, 2014
Published online: July 7, 2014
Abstract

AIM: To investigate the effect of gastric acid suppressants and prokinetics on peritonitis development in peritoneal dialysis (PD) patients.

METHODS: This was a single-center, retrospective study. The medical records of 398 PD patients were collected from January 2000 to September 2012 and analyzed to compare patients with at least one episode of peritonitis (peritonitis group, group A) to patients who never had peritonitis (no peritonitis group, group B). All peritonitis episodes were analyzed to compare peritonitis caused by enteric organisms and peritonitis caused by non-enteric organisms.

RESULTS: Among the 120 patients who met the inclusion criteria, 61 patients had at least one episode of peritonitis and 59 patients never experienced peritonitis. Twenty-four of 61 patients (39.3%) in group A and 15 of 59 patients (25.4%) in group B used gastric acid suppressants. Only the use of H2-blocker (H2B) was associated with an increased risk of PD-related peritonitis; the use of proton pump inhibitors, other antacids, and prokinetics was not found to be a significant risk factor for PD-related peritonitis. A total of 81 episodes of peritonitis were divided into enteric peritonitis (EP) or non-enteric peritonitis, depending on the causative organism, and gastric acid suppressants and prokinetics did not increase the risk of EP in PD patients.

CONCLUSION: The use of H2B showed a trend for an increased risk of overall PD-related peritonitis, although further studies are required to clarify the effects of drugs on PD-related peritonitis.

Keywords: Proton pump inhibitors, Histamine 2 receptor antagonists, Gastrointestinal motility, Peritoneal dialysis, Peritonitis

Core tip: Bacterial overgrowth/proliferation in an intraluminal environment with a high pH is a well-recognized mechanism for peritonitis development, especially in liver cirrhosis patients. Several studies have investigated whether this mechanism causes peritoneal dialysis (PD)-related peritonitis, although conflicting results have been obtained for the association between acid suppressive therapy and PD-related peritonitis. In addition, no study was conducted to evaluate the association between prokinetics and PD-related peritonitis. Therefore, we sought to assess the effect of gastric acid suppressants and prokinetics on PD-related peritonitis. In the present study, H2B use, but not proton pump inhibitor use, was identified as an independent risk factor for PD-related peritonitis development.