Could Proton Pump Inhibitors Increase Recurrent C difficile Risk?

The use of gastric acid suppressants, including proton pump inhibitors and histamine H₂ receptor blockers, is associated with a significantly increased risk of recurrent Clostridium difficile infection (CDI), according to the results of a recent study.

In order to determine the association between gastric acid suppressants and recurrent CDI, researchers conducted a systematic review and meta-analysis of data from 16 observational studies including 7703 patients with CDI, of which 1525 (19.8%) developed recurrent CDI.
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Overall, the rate of recurrent CDI among patients undergoing gastric acid suppression was 22.1%, compared with 17.3% among those without gastric acid suppression. Subgroup analyses of studies adjusting for age and potential confounders confirmed this association.

“Meta-analyses of observational studies suggest that patients who receive gastric acid suppressants may be at increased risk for recurrent CDI. These data should be interpreted with caution because they may be confounded owing to the observational design of the individual studies. It may be reasonable to re-evaluate the need for these medications in patients with CDI,” the researchers concluded.

—Michael Potts

Reference:

Tariq R, Signh S, Gupta A, et al. Association of gastric acid suppression with recurrent Clostridium difficile infection. JAMA Intern Med. 2017;177(6):784-791.