The use of acid suppression medicines was associated with higher rates of Clostridium difficile and Campylobacter positive gastroenteritis in both community and hospital settings, according to a study published in the British Journal of Clinical Pharmacology

To assess whether acid suppressors increased the risk of bacterial gastroenteritis, researchers conducted a population-based, propensity-score matched cohort study. Using a record-linkage database in Scotland, they included 188,323 patients exposed to acid suppressors, including proton pump inhibitors (PPIs), and H2 receptor agonists (H2RAs) between 1999–2013; a total of 376,646 controls not exposed to acid suppressors were also included. 

The study’s main outcome was a positive stool test for C. difficile, Campylobacter, Salmonella, Shigella or Escherichia coli O157.  

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Study authors reported positive test results for 15,273 C. difficile, 6,590 Campylobacter; 852 Salmonella, 129 Shigella, and 193 Escherichia coli O157 over a total of 5,729,743 person-years follow-up time. The adjusted hazard ratios (HRs) for culture positive diarrhea for patients exposed to PPIs and H2RA vs. unexposed cohort were 2.72 (95% CI: 2.33, 3.17) during follow-up time for community samples and 1.28 (95% CI: 1.08, 1.52) during follow-up time for hospital samples. 

Patients in the exposed group showed increased risks of C. difficile (adjust HR [aHR] 1.70, 95% CI: 1.28, 2.25) and Campylobacter (aHR 3.71, 95% CI: 3.04, 4.53) for community samples and for hospital samples (aHR 1.42, 95% CI: 1.17, 1.71 and aHR 4.53, 95% CI: 1.75, 11.8, respectively). 

Overall, findings from the study suggest that community-prescribed acid suppression medicines were associated with increased rates of positive stool samples for C. difficile and Campylobacter submitted from both the community and hospital settings.

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