In this case control study of cirrhotics with ascites, those on PPIs had a much higher risk of SBP than those not on PPIs (adjusted OR 4.3), and about half of the patients on PPIs had no indication. Although this study can not establish causality, it reminds us to review the necessity of PPIs in all inpatients, given the mounting evidence of potential harm of PPIs (risk of pneumonia, Clostridium difficile, fractures, and lower clopidogrel efficacy) (abstract).
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