Clinical

Medical therapy of portal hypertension lowers risk of bacterial peritonitis

Last Updated: 2006-02-03 13:23:51 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Pharmacologic prophylaxis of portal hypertension contributes to the prevention of community-acquired spontaneous bacterial peritonitis in patients with cirrhosis, according to a new report.

Previous research in cirrhotic rats indicates that beta-blockers reduce the incidence of bacterial translocation, the authors explain, suggesting that beta-blockers could prevent bacterial translocation and, consequently, spontaneous bacterial peritonitis in cirrhotic patients.

Dr. Begona Gonzalez-Suarez and colleagues from Hospital de Sant Pau, Barcelona, compared the long-term incidence of spontaneous bacterial peritonitis in cirrhotic patients randomized to pharmacologic combined treatment with beta-blockers and isosorbide mononitrate (115 patients) or endoscopic therapy (115 patients) to prevent variceal rebleeding.

Fifteen patients in the medication group and 32 patients from the endoscopic group required rescue treatment for severe rebleeding, the report in the January issue of the European Journal of Gastroenterology and Hepatology indicates.

Significantly fewer patients in the medication group (9%) developed at least one episode of spontaneous bacterial peritonitis during follow-up, the authors report, compared with the endoscopic group (14.7%).

The long-term probability of developing community acquired spontaneous bacterial peritonitis was significantly lower in patients receiving pharmacologic treatment (1% at one year, 8% at three years, 18% at five years) than in patients on endoscopic therapy (10% at one year, 20% at three years, 32% at five years), the researchers note. The groups did not differ in the rate of nosocomial spontaneous bacterial peritonitis.

Regardless of treatment group, there was a trend to a higher overall incidence of spontaneous bacterial peritonitis among patients with no hemodynamic response to treatment.

In a multivariate analysis, treatment group and previous spontaneous bacterial peritonitis were independent predictors of community acquired spontaneous bacterial peritonitis during follow-up.

The probability of survival did not differ between the two treatment groups.

"These results suggest that long-term pharmacologic prophylaxis of variceal rebleeding contributes to the prevention of community acquired spontaneous bacterial peritonitis," the authors conclude, "although this hypothesis needs to be confirmed with more controlled and randomized studies."

Eur J Gastroenterol Hepatol 2006;18:49-55.