Risk of Enteric Infection in Patients with Gastric Acid Supressive Drugs: A Population-Based Case-Control Study

Abstract

Long-term use of gastric-acid-suppressive drugs is known to be associated with several adverse effects. However, the association between enteric infection and acid suppression therapy is still uncertain. This study aimed to evaluate the association between gastric acid suppression and the risk of enteric infection. Materials and Methods: We conducted a population-based case-control study using the data from Chang Gung Research Database (CGRD) in Taiwan. Between January 2008 and December 2017, a total of 154,590 adult inpatients (age > 18) were identified. A pool of potential eligible controls according to four propensity scores matching by sex, age, and index year were extracted (n = 89,925). Subjects with missing data or who received less than 7 days of proton pump inhibitors (PPIs) and/or H2-receptor antagonists (H2RAs) were excluded. Finally, 17,186 cases and 69,708 corresponding controls were selected for analysis. The use of PPIs and H2RAs, the result of microbiological samples, and co-morbidity conditions have been analyzed. Confounders were controlled by conditional logistic regression. Results: 32.84% of patients in the case group used PPIs, compared with 7.48% in the control group. Of patients in the case group, 9.9% used H2RAs, compared with 6.9% in the control group. Of patients in the case group, 8.3% used a combination of PPIs and H2RAs, compared with 2.7% in the control group. The most common etiological pathogens were Enterococcus (44.8%), Clostridioides difficile (34.5%), and Salmonella spp. (10.2%). The adjusted odds ratio (OR) for PPI use with enteric infection was 5.526 (95% confidence interval [CI], 5.274–5.791). For H2RAs, the adjusted odds ratio was 1.339 (95% confidence interval [CI], 1.261–1.424). Compared to the control group, persons with enteric infection had more frequent acid-suppressive agent usage. Conclusions: This study demonstrates that gastric-acid-suppressive drug use is associated with an increased risk of enteric infection after adjusting for potential biases and confounders.

Prebiotic prevents the development of gastrointestinal motility disorders caused by omeprazole

“…It is known that long-term hypochlorhydria leads to the development of dysbacteriosis and hypergastrinemia, which in turn cause the inflammatory process in the stomach and intestines, the syndrome of excessive growth of microorganisms in the small intestine, and functional disorders in the liver and pancreas [16,17]. Also, it enhances the risk of enteric infections in patients with gastric acid suppressive drugs [18]. In turn, impaired motility of the digestive tract contributes to the colonization of the stomach by intestinal microflora.…”

Association of metabolic dysfunction-associated fatty liver disease with gastrointestinal infections: insights from National Inpatient Sample Database

“…This increased risk is thought to be due to a reduction in gastric acid, making the stomach more hospitable to pathogenic, enteric organisms. Furthermore, PPI use can alter the gut microbiome and alter the function of immune cells, both of which may contribute to an increased infection risk 25. We acknowledge that PPI use was not assessed in our study.…”

Current management of gastro-oesophageal reflux disease—treatment costs, safety profile, and effectiveness: a narrative review

“…PPIs also raise the pH of the duodenum and jejunum, which enhances C. difficile spore germination and vegetation in the presence of primary bile salts. The prevalent use of PPIs is associated with both hospital-acquired and community-acquired C. difficile colitis [ 31 , 32 , 35 ] ( Figure 2 ).…”

“…This results in an ultra-rapid metabolizer phenotype and potential decreased efficacy of pantoprazole, omeprazole, or lansoprazole in treating erosive oesophagitis or gastroduodenal ulceration. Thus, polymorphisms in CYP2C19 may explain some of the variability in GORD symptom control and potential adverse side effects across differing PPI drugs and patient populations [ 22 , 32 , 39 , 41 ].…”