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On reviewing published studies and information from the FDA's Adverse Event Reporting System, the FDA warned the public that use of proton-pump inhibitors (PPIs) may increase the risk for Clostridium difficile–associated diarrhea (CDAD). Although the strength of the association varied widely among studies, most studies found risk for C. difficile infection or disease to be 1.4 to 2.75 times higher in patients with PPI exposure than in those without. Many of the patients affected also had other risk factors, such as antibiotic use, older age, or certain comorbid conditions.
PPIs (and possibly histamine-2 antagonists) alter the gastric pH and can allow overgrowth of C. difficile. Several of these agents are now sold over the counter, without n…