ORLANDO — Patients on proton pump inhibitor therapy before abdominal cancer surgery were four times more likely to have postoperative infections than were those not taking such medication, according to a prospective, observational study.
Patients taking preoperative proton pump inhibitors (PPIs) also had significantly elevated serum levels of tumor necrosis factor (TNF)-α before and immediately after hemihepatectomy, as well as the day after surgery. Pneumonia and wound infections made up the majority of postoperative infections in the PPI group.
“There is evidence that PPIs have an effect on the immune system, especially TNF-α,” Dr. Felix Kork said in an interview. Other researchers have shown that TNF-α impairs the immune system (J. Gastrointest. Surg. 2007;11:1506–14), yet the exact mechanism of interaction between PPI use and this cytokine remains unknown. Inflammation could play a role, particularly with postoperative pneumonia, he added.
These findings from patients at Charité Medical University of Berlin need to be confirmed before physicians consider preoperative suspension of PPIs, said Dr. Kork, an anesthesiology and intensive-care medicine resident. “We should investigate this further—whether or not it helps to stop PPIs,” he said in a poster presented at the annual meeting of the American Society of Anesthesiologists.
Previously, researchers demonstrated that PPIs alter the expression of cytokines in antrum cells (Inflamm. Res. 2006;55:476–80). Also, polymorphisms of TNF-α have been shown to reduce eradication of Helicobacter pylori (Scand. J. Immunol. 2008;67:57–62).
Among the 166 patients who completed the current study, Dr. Kork and his colleagues found that 13 of 44 (30%) in the preoperative PPI group developed a postoperative infection, versus only 10 of 122 (8%) of the non-PPI patients. This difference was significant (odds ratio, 4.13).
“Those patients preoperatively taking PPIs also have an elevated total length of stay,” Dr. Kork said. This difference was statistically significant, compared with patients not taking PPIs before surgery, he said, although he did not present the number of days associated with length of stay.
Length of ICU stay did not differ significantly between groups, he added.
'We should investigate this further—whether or not it helps to stop PPIs.' DR. KORK