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Acid suppression drugs associated with GI infection risk
Proton pump inhibitors and H2 receptor antagonists were associated with an increased risk for bacterial gastroenteritis resulting from Clostridium difficile and Campylobacter infections, according to the results of a population-based study.
“Users of these medications should be particularly vigilant about food hygiene as the removal of stomach acid makes them more easily infected with agents such as Campylobacter, which is commonly found on poultry,” Thomas MacDonald, MD, PhD, MPH, of the Medicines Monitoring Unit, University of Dundee, Ninewells Hospital and Medical School, U.K., said in a press release.
MacDonald and colleagues used a population-based, record-linkage database to identify 188,323 patients from a community in Scotland who received acid suppression drugs between 1999 and 2013 and compared them with 376,646 propensity-score matched controls from the same community who were not exposed to acid suppression drugs during the same period.
Positive stool tests for C. difficile, Campylobacter, Salmonella, Shigella or Escherichia coli O157 served as the primary outcome, and the researchers used a Cox regression model to determine the association between acid suppression drugs and the risk for bacterial gastroenteritis.
The researchers identified 22,705 positive test results over more than 5.7 million person-years of follow-up, primarily C. difficile (15,273) and Campylobacter infections (6,590), which were not mutually exclusive.
Overall, patients who were exposed to either PPIs (59%) or H2RAs (41%) were more than twice as likely to have culture positive diarrhea compared with those who were unexposed (adjust HR = 2.72; 95% CI, 2.33-3.17), and the risk was smaller but still significantly increased among exposed vs. unexposed hospitalized patients (aHR = 1.28; 95% CI, 1.08-1.52).
The risk for C. difficile infection was 1.7 times higher in the exposed cohort based on samples submitted from the community (aHR = 1.7; 95% CI, 1.28-2.25) and 1.42 times higher in the exposed cohort based on samples submitted from hospitals (aHR = 1.42; 95% CI, 1.17-1.71), while the risk for Campylobacter was 3.7 times higher (aHR = 3.71; 95% CI, 3.04-4.53) and 4.5 times higher (aHR = 4.53; 95% CI, 1.75-1.18) based on community and hospital samples, respectively.
The researchers observed “a clear dose response relationship between acid suppression medication and culture negative outcomes [which] may support a causal relationship between acid suppressing medications and symptoms that lead to stool culture,” they wrote. “However, we did not observe a dose-response relationship for stool tested positive diarrhea due to C. difficile and Campylobacter.”
Limitations of the study include that non-prescription drugs were not accounted for, a limited range of pathogens were evaluated, NSAID use was not adjusted for, and several other confounding factors may have been unrecorded, the investigators noted.
They concluded that exposure to PPIs or H2RAs increase the risk for both bacterial GI infections and culture negative stool samples submitted for presumed diarrhea. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.