Acid-suppression medications and bacterial gastroenteritis: a population-based cohort study

Br J Clin Pharmacol. 2017 Jun;83(6):1298-1308. doi: 10.1111/bcp.13205. Epub 2017 Jan 23.

Abstract

Aims: To investigate whether acid-suppression medicines (ASMs) increase the risk of bacterial gastroenteritis.

Methods: A population-based, propensity-score matched cohort study using a record-linkage database in Tayside, UK. The study consisted of 188 323 exposed to ASMs (proton-pump inhibitors and histamine-2 receptor antagonists) and 376 646 controls (a propensity-score matched cohort from the rest of population who were not exposed to ASMs) between 1999 and 2013. The main outcome measure was a positive stool test for Clostridium difficile, Campylobacter, Salmonella, Shigella or Escherichia coli O157. The association between ASMs and risk of bacterial gastroenteritis was assessed by a Cox regression model.

Results: There were 22 705 positive test results (15 273 C. difficile [toxin positive], 6590 Campylobacter, 852 Salmonella, 129 Shigella and 193 E. coli O157, not mutually exclusive) with a total of 5 729 743 person-years follow up time in Tayside, 1999-2013. The adjusted hazard ratios for culture positive diarrhoea for the proton-pump inhibitors and histamine-2 receptor antagonists exposed vs. unexposed cohort were 2.72 (95% confidence interval [CI] 2.33, 3.17) during follow-up time for samples submitted from the community and 1.28 (95% CI 1.08, 1.52) for samples submitted from hospitals. Compared with the unexposed cohort, patients in the exposed group had increased risks of C. difficile and Campylobacter [adjusted hazard ratios of 1.70 (95% CI 1.28, 2.25), 3.71 (95% CI 3.04, 4.53) for community samples, and 1.42 (95% CI 1.17, 1.71), 4.53 (95% CI 1.75, 11.8) for hospital samples, respectively].

Conclusions: The results suggest that community prescribed ASMs were associated with increased rates of C. difficile and Campylobacter positive gastroenteritis in both the community and hospital settings.

Keywords: acid-suppression medications; bacterial gastroenteritis; cohort study.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bacterial Infections / epidemiology*
  • Bacterial Infections / microbiology
  • Child
  • Child, Preschool
  • Cohort Studies
  • Diarrhea / microbiology
  • Dose-Response Relationship, Drug
  • Female
  • Gastroenteritis / epidemiology*
  • Gastroenteritis / microbiology
  • Histamine H2 Antagonists / adverse effects*
  • Humans
  • Inpatients
  • Male
  • Medical Records
  • Middle Aged
  • Omeprazole / adverse effects
  • Proton Pump Inhibitors / adverse effects*
  • Registries
  • Risk
  • United Kingdom / epidemiology
  • Young Adult

Substances

  • Histamine H2 Antagonists
  • Proton Pump Inhibitors
  • Omeprazole