Gastric Acid Suppression Linked With Increased Risk of Recurrent CDI

Patients who receive gastric acid suppressants may be at increased risk for recurrent <i>Clostridium difficile</i> infection. <i>Photo Credit: CDC/Dr Gilda Jones.</i>
Patients who receive gastric acid suppressants may be at increased risk for recurrent Clostridium difficile infection. Photo Credit: CDC/Dr Gilda Jones.

Findings from a meta-analysis of 16 studies suggest that patients who take gastric acid suppressants may have a higher risk for recurrent Clostridium difficile infection (CDI), according to Raseen Tariq, MBBS, from the Mayo Clinic, Rochester, MN.

In this study, Tariq and colleagues aimed to evaluate the relationship between gastric acid suppressant use and recurrent CDI. Previous studies have indicated a link between these medications and an increased risk of primary CDI. The team searched several databases from January 1, 1995 to September 30, 2015 for case-control studies, cohort studies, and clinical trials assessing the association between gastric acid suppressant use and recurrent CDI. 

The main outcome of the analyses was the risk of recurrent infection in patients with CDI and its relation to the use of gastric acid suppressants. A total of 16 studies, including 7703 patients with CDI, were included. Of the total patients, 19.8% (n=1525) developed recurrent CDI.

The rate of CDI was higher in patients with gastric acid suppression vs patients without acid suppression (22.1% vs 17.3%; odds ratio (OR) 1.52, 95% CI 1.20-1.94; <.001). No significant heterogeneity among the studies was noted. Data from subgroup analyses that adjusted for age and possible confounders further confirmed a higher risk of recurrent CDI with the use of gastric acid suppressants (OR 1.38, 95% CI 1.08-1.76; =.02). 

Tariq added, "These data should be interpreted with caution because they may be confounded owing to the observational design of the individual studies." It may be prudent to assess the need for gastric acid suppressants in patients with CDI, the researchers concluded. 

Reference

Tariq R, Singh S, Gupta A, et al. Association of gastric acid suppression with recurrent Clostridium difficile infection: a systematic review and meta-analysis [published online March 27, 2017]. JAMA. doi: 10.1001/jamainternmed.2017.0212

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