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

Area of Science:

• Gastroenterology
• Infectious Diseases
• Pharmacology

Background:

• Acid-suppression medicines (ASMs), including proton-pump inhibitors and histamine-2 receptor antagonists, are widely prescribed.
• Concerns exist regarding the potential adverse effects of ASMs on the gastrointestinal microbiome and infection risk.

Purpose of the Study:

• To investigate the association between acid-suppression medicine use and the risk of developing bacterial gastroenteritis.
• To determine if ASMs increase the incidence of specific bacterial infections, such as Clostridium difficile and Campylobacter.

Main Methods:

• A population-based, propensity-score matched cohort study was conducted using a UK Tayside record-linkage database from 1999 to 2013.
• The study included 188,323 individuals exposed to ASMs and 376,646 matched controls.
• Bacterial gastroenteritis was identified through positive stool tests for C. difficile, Campylobacter, Salmonella, Shigella, or E. coli O157, with analysis using Cox regression.

Main Results:

• A total of 22,705 positive stool tests were recorded during the study period.
• Individuals exposed to ASMs showed significantly increased adjusted hazard ratios for culture-positive diarrhea compared to unexposed controls.
• Specific increases in risk were noted for Clostridium difficile and Campylobacter infections in both community and hospital-submitted samples.

Conclusions:

• Community-prescribed ASMs are associated with elevated rates of bacterial gastroenteritis.
• The findings suggest a causal link between ASM use and increased risk of C. difficile and Campylobacter infections.
• This association holds true for infections diagnosed in both community and hospital settings.