PPIs Are Associated with Risk for Bacterial Gastroenteritis

Normal gastric acidity protects against development of bacterial gastroenteritis (GE); achlorhydric patients have higher risk for GE. Limited data suggest that acid-reduction therapy also confers higher risk for GE. To evaluate this possibility further, investigators in the U.K. used the General Practice Research Database to identify 6414 patients who presented with bacterial GE from 1992 through 2001. These patients were matched with 50,000 controls from the same database by age, sex, and calendar year.

Logistic regression analysis showed that patients with GE were more likely than controls to be taking proton-pump inhibitors (PPIs) but not histamine-2–receptor antagonists (H₂RAs). PPI users were significantly more likely to develop GE than were nonusers (relative risk, 2.9; 95% CI, 2.4–3.5). Risk increased when PPI doses were doubled (RR, 5.0; 95% CI, 2.7–9.3). H₂RA use was not associated with bacterial GE (RR, 1.1; 95% CI, 0.9–1.4). Omeprazole and lansoprazole conferred similar risk for GE, and the specific bacterium responsible for diarrhea (campylobacter or salmonella) did not affect the relative risks associated with the drugs. GE was associated with alcoholism, low body-mass index, recent use of antidiarrheals, and use of antibiotics during the prior week. The authors concluded that PPI therapy, but not H₂RA therapy, led to higher risk for campylobacter- or salmonella-associated GE.