[PHNUTR-L] Use of Acid-suppressing drugs and the risk of bacterial
fivestar at nutritionucanlivewith.com
Tue Dec 18 17:45:06 PST 2007
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Clin Gastroenterol Hepatol. 2007 Dec;5(12):1418-23.Links
Use of Acid-suppressing drugs and the risk of bacterial
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]
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
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