Elevated Bacterial Gastroenteritis Risk With Acid Suppression Drugs

Higher rates of both Clostridium difficile- and Campylobacter- positive gastroenteritis were seen in both community and hospital settings.
Higher rates of both Clostridium difficile- and Campylobacter- positive gastroenteritis were seen in both community and hospital settings.

The use of acid suppression medicines was associated with higher rates of Clostridium difficile and Campylobacter positive gastroenteritis in both community and hospital settings, according to a study published in the British Journal of Clinical Pharmacology

To assess whether acid suppressors increased the risk of bacterial gastroenteritis, researchers conducted a population-based, propensity-score matched cohort study. Using a record-linkage database in Scotland, they included 188,323 patients exposed to acid suppressors, including proton pump inhibitors (PPIs), and H2 receptor agonists (H2RAs) between 1999–2013; a total of 376,646 controls not exposed to acid suppressors were also included. 

The study's main outcome was a positive stool test for C difficile, Campylobacter, Salmonella, Shigella or Escherichia coli O157. 

Study authors reported positive test results for 15,273 C difficile, 6,590 Campylobacter; 852 Salmonella, 129 Shigella, and 193 Escherichia coli O157 over a total of 5,729,743 person-years follow-up time. The adjusted hazard ratios (HRs) for culture positive diarrhea for patients exposed to PPIs and H2RA vs. unexposed cohort were 2.72 (95% CI: 2.33, 3.17) during follow-up time for community samples and 1.28 (95% CI: 1.08, 1.52) during follow-up time for hospital samples. 

Patients in the exposed group showed increased risks of C difficile (adjust HR [aHR] 1.70, 95% CI: 1.28, 2.25) and Campylobacter (aHR 3.71, 95% CI: 3.04, 4.53) for community samples and for hospital samples (aHR 1.42, 95% CI: 1.17, 1.71 and aHR 4.53, 95% CI: 1.75, 11.8, respectively). 

Overall, findings from the study suggest that community-prescribed acid suppression medicines were associated with increased rates of positive stool samples for C difficile and Campylobacter submitted from both the community and hospital settings.

Reference

Wei L, Ratnayake L, Phillips G, et al. Acid suppression medications and bacterial gastroenteritis: a population-based cohort study [Published online January 5, 2017]. Brit J Clin Pharmaco. doi: 10.1111/bcp.13205

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