Acid suppression therapy, gastrointestinal bleeding and infection in acute pancreatitis - An international cohort study.

Acute Disease Adult Aged Aged, 80 and over Clostridioides difficile Cohort Studies Enterocolitis, Pseudomembranous / complications Feces / microbiology Female Gastrointestinal Hemorrhage / drug therapy Hospitalization Humans Infections / complications Male Middle Aged Pancreatitis / complications Proton Pump Inhibitors / adverse effects Retrospective Studies Risk Factors Surveys and Questionnaires Treatment Outcome

Acid suppressing drug Acute pancreatitis Gastrointestinal bleeding Gastrointestinal infection Proton pump inhibitor

Journal

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]

ISSN: 1424-3911

Titre abrégé: Pancreatology

Pays: Switzerland

ID NLM: 100966936

Informations de publication

Date de publication:
Oct 2020

Historique:

received: 12 08 2020

accepted: 13 08 2020

pubmed: 20 9 2020

medline: 18 9 2021

entrez: 19 9 2020

Statut: ppublish

Résumé

Acid suppressing drugs (ASD) are generally used in acute pancreatitis (AP); however, large cohorts are not available to understand their efficiency and safety. Therefore, our aims were to evaluate the association between the administration of ASDs, the outcome of AP, the frequency of gastrointestinal (GI) bleeding and GI infection in patients with AP. We initiated an international survey and performed retrospective data analysis on AP patients hospitalized between January 2013 and December 2018. Data of 17,422 adult patients with AP were collected from 59 centers of 23 countries. We found that 23.3% of patients received ASDs before and 86.6% during the course of AP. ASDs were prescribed to 57.6% of patients at discharge. ASD administration was associated with more severe AP and higher mortality. GI bleeding was reported in 4.7% of patients, and it was associated with pancreatitis severity, mortality and ASD therapy. Stool culture test was performed in 6.3% of the patients with 28.4% positive results. Clostridium difficile was the cause of GI infection in 60.5% of cases. Among the patients with GI infections, 28.9% received ASDs, whereas 24.1% were without any acid suppression treatment. GI infection was associated with more severe pancreatitis and higher mortality. Although ASD therapy is widely used, it is unlikely to have beneficial effects either on the outcome of AP or on the prevention of GI bleeding during AP. Therefore, ASD therapy should be substantially decreased in the therapeutic management of AP.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

We initiated an international survey and performed retrospective data analysis on AP patients hospitalized between January 2013 and December 2018.

RESULTS RESULTS

Data of 17,422 adult patients with AP were collected from 59 centers of 23 countries. We found that 23.3% of patients received ASDs before and 86.6% during the course of AP. ASDs were prescribed to 57.6% of patients at discharge. ASD administration was associated with more severe AP and higher mortality. GI bleeding was reported in 4.7% of patients, and it was associated with pancreatitis severity, mortality and ASD therapy. Stool culture test was performed in 6.3% of the patients with 28.4% positive results. Clostridium difficile was the cause of GI infection in 60.5% of cases. Among the patients with GI infections, 28.9% received ASDs, whereas 24.1% were without any acid suppression treatment. GI infection was associated with more severe pancreatitis and higher mortality.

CONCLUSIONS CONCLUSIONS

Although ASD therapy is widely used, it is unlikely to have beneficial effects either on the outcome of AP or on the prevention of GI bleeding during AP. Therefore, ASD therapy should be substantially decreased in the therapeutic management of AP.

Identifiants

DOI: 10.1016/j.pan.2020.08.009 PMID: 32948430

pubmed: 32948430

pii: S1424-3903(20)30658-X

doi: 10.1016/j.pan.2020.08.009

pii:

doi:

Substances chimiques

Proton Pump Inhibitors 0

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

1323-1331

Informations de copyright

Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.