Long-term acid reducers thriple risk of C. Diff

[Guest guest]

Some docs are quick to put us on longterm acid-reducers to try to prevent reflux

- instead of finding and fixing the PROBLEM causing the reflus - often, a

too-tight or mis-placed Band.

As with all medications, there are risks.

" C. Difficile " is a very nasty type of intense long-lasting diarrhea that is

very difficult to get rid of - hence the name DIFFICILE.

Sandy

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Acid Reducers Triple Risk of C difficile-Associated Diarrhea

M. Keller, PhD

NowSeptember 22, 2011 (Chicago, Illinois) — In a retrospective study from

Japan, chronic use of proton pump inhibitors (PPIs) was found to be associated

with a greater than 3-fold increased risk of developing Clostridium

difficile–associated diarrhea (CDAD), Takatoshi Kitazawa, MD, assistant

professor at Teikyo University in Tokyo, Japan, reported during a poster session

here at the 51st Interscience Conference on Antimicrobial Agents and

Chemotherapy.

Dr. Kitazawa noted that previous retrospective studies showing a positive

relation between the use of PPIs and CDAD were carried out in western countries.

The researchers wanted to see if there was a similar effect at a single

institution in Japan.

The study comprised all patients admitted to the Department of Internal Medicine

at the university hospital from April to June 2010. Researchers continued to

collect test results for C difficile toxins until April 2011. A PPI user was

defined as any patient who was prescribed a PPI for more than 30 days. A case

was considered to be CDAD if a patient had diarrhea and C difficile toxins in a

stool sample.

During the study period, PPIs were prescribed to 487 (59.8%) of 816 patients.

PPI users were older than nonusers (68.9 vs 63.1 years; P < .01), and the

male/female ratio was higher among users than among nonusers (2.26 vs 1.36; P <

..01)

PPI users had a 3.2-fold increased risk of developing CDAD. Among the 487 PPI

users, there were 19 cases of CDAD; among the 329 nonusers, there were 4 cases

of CDAD (relative risk, 3.20; 95% confidence interval, 1.10 to 9.32; P = .02).

Dr. Kitazawa told Medscape Medical News that he thinks that PPIs should be

prescribed more cautiously and only when necessary.

He also believes that H2 blockers put patients at risk for CDAD. For patients

needing relief of stomach acid, especially older patients, he recommends a

magnesium-containing antacid.

After a news conference at the meeting, Clifford Mc, MD, chief of the

Prevention and Response Branch, Division of Healthcare Quality Promotion, US

Centers for Disease Control and Prevention, Atlanta, Georgia, told Medscape

Medical News that there is conflicting observational evidence about the relation

between PPI use and CDAD.

" There's always the concern about confounding. These tend to be sicker people.

They tend to be people who get more antibiotics. [Researchers] try to control

for this, " he explained. " These observational studies are not going to put an

end to the questions, " he said, noting that randomized controlled trials are

needed.

He agreed that PPI use should probably be more limited. " There are a lot of

people on these PPIs who probably don't absolutely need to be on them. Doing a

screening program and pulling people off PPIs in a randomized fashion and seeing

what their C difficile risk is...[is] one study that has been proposed by

people. I don't think it's been carried out, " Dr. Mc said.

Besides a potential risk for C difficile infections, PPIs are costly and they

can interfere with calcium absorption because of hypochlorhydria; they also have

the potential to increase the risk for bone fractures.

Dr. Mc reported that observational studies have shown a graded effect of

acid reducers on the development of C difficile problems. " There's one published

study that shows a dose–response effect with the more potent stomach acid

suppressors — the PPIs being more potent than the H2 blockers — and they showed

a gradation in effect. That suggested that maybe the pathogenesis of this is

acid reduction. Of course, spores are relatively acid-resistant. Others have

said that maybe this is really an antibiotic effect of the PPIs changing the

flora of the lower intestine, " he said.

The study had no commercial support. Dr. Kitazawa and Dr. Mc have

disclosed no relevant financial relationships.

51st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC):

Abstract K-201. Presented September 17, 2011.