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 The pills work by stopping cells in the stomach lining from
producing too much of the acid that can cause ulcers and reflux
symptoms such as heartburn.
Researchers examined data on about 188,000 people who used these
drugs and about 377,000 similar individuals who didn’t take PPIs.
Compared to people who didn’t use the drugs, those who did were at
higher risk for a severe form of diarrhea caused by the Clostridium
difficile bacteria. Their odds of this infection were 1.4 times
higher when they were hospitalized and 1.7 times higher when they
weren’t in the hospital.
In addition, PPI users had a 4.5 times greater risk of getting
Campylobacter infections, a common form of food poisoning, if they
were hospitalized and a 3.7 times higher risk when they weren’t
hospitalized.
“Reducing stomach acid, which acts as a barrier to infection,
increases the chance of getting a GI infection,” said senior study
author Dr. Thomas MacDonald, a pharmacology researcher at the
University of Dundee in Scotland.
“The main risk of PPIs are gastrointestinal infections,” MacDonald
added by email.
MacDonald and colleagues analyzed data on stool samples collected
from patients in Scotland between 1999 and 2013.
Overall, there were 22,705 positive test results for bacterial
infections. This included 15,273 people with C. difficile and 6,590
cases of Campylobacter, the authors reported in the British Journal
of Clinical Pharmacology.
Researchers also tested for Salmonella, Shigella and Escherichia
coli, or E. coli, but didn’t find an association between PPIs and
these infections.
One limitation of the study is that it only included data on people
who took PPIs with a prescription, even though these drugs have been
available in Scotland since 2004 without a prescription, the authors
note. Researchers also lacked data on other factors that can
influence the risk of bacterial infections such as obesity, smoking
and alcohol use.
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Previous research on PPIs and infections has produced mixed results,
with some studies suggesting an association and others failing to
establish a connection, noted Dr. Wojciech Marlicz, a
gastroenterology researcher at Pomeranian Medical University in
Poland who wasn’t involved in the study.
Millions of people worldwide take PPIs, which are available without
a prescription in Europe and the U.S., which means even a slight
increase in the odds of bacterial infections can still impact a lot
of patients.
“The main problem with PPI use is their general overuse,” Marlicz
said by email. “These drugs are very potent and safe when used
according to indication.”
“Some patients will gain clear benefits from PPIs as they have
stomach problems, such as ulcers which will heal better with less
acid,” said Dr. Claire Steves, a researcher at King's College London
who wasn’t involved in the study.
“However other patients may take these as preventatives, or for mild
symptoms,” Steves added by email. “This study would prompt us to
reassess the risk and benefit for each individual, and in some cases
alternatives – such as changing diet or lifestyle – may be better
options.”
SOURCE: http://bit.ly/2ifBGbp British Journal of Clinical
Pharmacology, online January 5, 2017.
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