PPIs linked to higher gastro risk


woman with indigestion

Users of acid suppression drugs should be vigilant about food hygiene due to increased risk of bacterial gastroenteritis

Researchers in Scotland have found a positive association between use of acid suppression drugs such as proton pump inhibitors (PPIs) and H2 receptor antagonists (H2RAs), and an increased risk of infection with bacteria causing gastroenteritis.

The large population-based cohort study matched 188,323 people exposed to PPIs and H2RAs between 1999 and 2013, with 376,646 controls.

During this period there were 22,705 positive stool test results within the cohort: 15,273 for Clostridium difficile (toxin positive), 6,590 Campylobacter, 852 Salmonella, 193 Escherichia coli and 129 Shigella.

Results showed that compared with the unexposed cohort, patients in the community using PPIs or H2RAs had a 1.7-times increased risk of C. difficile gastrointestinal infection and 3.7-times increased risk for Campylobacter.

Among hospitalised patients, those using the medications had a 1.4-times increased risk and a 4.5-times increased risk respectively.

While acid suppression medicines are often considered relatively free from adverse effects, these results suggest there are significant adverse gastrointestinal consequences of their use, the study authors warn.

“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,” said Professor Thomas MacDonald, senior author of the British Journal of Clinical Pharmacology study.

The higher risk of C. difficile infection in PPI users is based on the increased ability of the acid-resistant spore to survive in a hypo-acid environment, the authors suggest.

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