Use of Acid-suppressing drugs and the risk of bacterial gastroenteritis

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Clin Gastroenterol Hepatol. 2007 Dec;5(12):1418-23.Links

Use of Acid-suppressing drugs and the risk of bacterial

gastroenteritis.

García Rodríguez LA, Ruigómez A, Panés J.

Centro Español de Investigación Farmacoepidemiológica, Madrid, Spain.

Background & Aims: Gastric acid is a defense mechanism against

gastrointestinal infections caused by ingested bacteria. Studies have

suggested that the use of acid-suppressing drugs may increase the risk

of gastroenteritis (GE). Methods: Patients aged 20-74 years with an

episode of acute bacterial GE (n = 6414) were identified. A control

group from the same study population without a diagnosis of GE (n =

50,000) was frequency-matched by age, sex, and calendar year to the case

group. Unconditional logistic regression was used to calculate the

adjusted relative risk (RR) of GE in patients using proton pump

inhibitors (PPIs) or histamine-2 receptor antagonists (H(2)RAs).

Results: Current use of PPIs was associated with an increased risk of

bacterial GE compared with nonuse, regardless of the treatment duration

(RR, 2.9; 95% confidence interval [CI], 2.5-3.5), whereas no association

was observed with H(2)RA use (RR, 1.1; 95% CI, 0.9-1.4). Doubling the

PPI dose further increased the risk of developing bacterial GE (RR, 5.0;

95% CI, 2.7-9.3). The effect of PPI use did not vary significantly with

regard to treatment indication. The increased risk associated with PPI

use was similar for both omeprazole (RR, 3.0; 95% CI, 2.5-3.7) and

lansoprazole (RR, 2.1; 95% CI, 1.4-3.0), whereas neither cimetidine nor

ranitidine showed any increased risk. Campylobacter (n = 4124) and

Salmonella (n = 1885) were the 2 species most frequently responsible for

GE episodes in the case group. When analyzed separately, both species

reproduced the increased risk associated with PPI use and not H(2)RA

use. Clostridium GE cases were rare (n = 31). Conclusions: This study

suggests that gastric acid suppression induced by PPIs but not H(2)RAs

is associated with an increased risk of Campylobacter and Salmonella GE.

PMID: 18054750 [PubMed - in process]

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