PPIs and Gastroenteritis Hospitalization: What's the Risk?
NEW ORLEANS, LA—Use of proton pump inhibitors (PPIs) was tied to a higher risk of infectious gastroenteritis hospitalization with increasing risk among increasing doses, presented Yingxi Chen, BM, MPH, from the Australian National University, Canberra, Australia, at IDWeek 2016.
PPIs, though commonly prescribed across the world, have been associated with bacteria gastroenteritis. Chen and coauthors attempted to measure the association between PPI use, type, and dose with infectious gastroenteritis hospitalization in a population-based cohort of middle-aged and older adults.
The prospective study included 38,019 concession card holders (median age 69.7 years) followed up for >6 years in the Sax Institute's 45 and Up Study. Multiple health databases were accessed for information on prescription medication data, hospitalization, notifiable disease, cancer registry and death from 2006–2012. Cox proportional hazard models were used to assess associations between PPI use and gastroenteritis hospitalization with age as the underlying time variable, adjusted for sociodemographic and health covariates, and use of other medications.
Study authors found that current PPI users were more likely to be older and have a higher BMI than non-users. The most frequently dispensed PPI was esomeprazole (30.1%), followed by omeprazole (25.2%) and pantoprazole (21.4%).
A total of 1,982 incident hospitalizations for gastroenteritis (crude rate: 12.9 per 1000 person-years, 95% CI: 12.3–13.5) were documented during follow-up. The adjusted relative risk of infectious gastroenteritis hospitalization was significantly higher in current PPI users (adjusted hazard ratio [aHR] 1.4, 95% CI: 1.2–1.5) vs. non-users. For current users, a dose-response relationship was seen between the average daily dose (DDD) prescribed per day and infectious gastroenteritis hospitalization (Ptrend<0.001).
"There was no difference in risk by type of PPI," noted Chen. "Recent use of H2 receptors was nota associated with gastroenteritis hospitalization."
When compared to non-users, aHRs were 1.1 (95% CI: 0.9–1.3), 1.4 (95% CI: 1.3–1.6) and 1.6 (95% CI: 1.3–1.8) among patients with a dose ≤0.5 average daily dose per day, 0.5–1 average daily dose per day, and >1 average daily dose per day, respectively. This dose-response relationship was sustained when analyses were restricted to participants with a history of chronic bowel problems (Ptrend<0.001).
The findings suggest that healthcare professionals "should be aware of this risk when considering PPI therapy, and use the lowest effective dose for patients with appropriate indications."