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Review article: infective complications of therapeutic gastric acid inhibition
1University of Cambridge Department of Anatomy, Royal Free Hospital, London, UK.
Abstract:
Gastric acid secretion has a non-specific bactericidal action which contributes to gastrointestinal defence mechanisms against micro-organisms. Therapeutic inhibition of acid secretion with histamine H2 receptor antagonists and proton pump inhibitors might therefore be expected to predispose to infection. This article reviews clinical reports of infection occurring during therapeutic gastric acid inhibition, and assesses the risk of infection incurred by such treatment. Non-typhoid salmonelloses, Campylobacter infections, local candidiasis, and possibly Strongyloides hyperinfections may be more prevalent after acid inhibitory treatment, but concurrent impairment of other gastrointestinal defence mechanisms may be necessary to permit infection.
Insights
Therapeutic inhibition of gastric acid secretion may increase the risk of certain infections, such as salmonellosis and campylobacter infections. Other gastrointestinal defense mechanisms may also need to be impaired for infection to occur.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pharmacology
Background:
- Gastric acid secretion acts as a natural defense against microbial invasion of the gastrointestinal tract.
- Medications that inhibit gastric acid, like histamine H2 receptor antagonists and proton pump inhibitors, may compromise this protective barrier.
Purpose of the Study:
- To review clinical reports of infections associated with therapeutic gastric acid inhibition.
- To assess the infection risk posed by treatments that reduce stomach acid production.
Main Methods:
- Literature review of clinical reports.
- Analysis of infection incidence during acid-inhibitory therapy.
Main Results:
- Increased prevalence of non-typhoid salmonelloses and Campylobacter infections observed.
- Potential increased risk of local candidiasis and Strongyloides hyperinfections noted.
- Infection may require concurrent impairment of other gastrointestinal defenses.
Conclusions:
- Therapeutic gastric acid inhibition may predispose individuals to specific infections.
- The risk is likely influenced by the type of pathogen and the integrity of other host defense mechanisms.