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All Boards >> Irritable Bowel Syndrome Research Library

HeatherAdministrator

Reged: 12/09/02
Posts: 7423
Loc: Seattle, WA
Hearburn Drugs Cause Diarrhea
01/08/06 05:10 PM

Commonly used heartburn drugs appear to be contributing to the rapid increase of community-acquired Clostridium difficile diarrheal infection.

Suppression of gastric acid with proton-pump inhibitors drugs like Prilosec (omeprazole) or Nexium (esomeprazole) is associated with a two- to threefold increase in the risk of community acquired Clostridium difficile, according to researchers here.


The finding supports the hypothesis that the mechanism of increased C. difficile risk is related to the degree of gastric acid suppression, Sandra Dial, M.D., M.Sc., of McGill University and colleagues reported in the Dec. 21 issue of the Journal of the American Medical Association.


Analysis of medical records from patients treated by general practitioners in England found that the incidence of C. difficile diagnosed by GPs jumped from less than 1 case per 100,000 population in 1994 to 22 cases per 100,000 in 2004.


That increase is mainly due to the increased use of gastric acid suppressors, wrote Dr. Dial and colleagues.


The adjusted relative risk for current proton pump inhibitor exposure was 2.9 and the adjusted relative risk for current H2 -receptor agonist exposure was 2.0. Current exposure to NSAIDs, but not aspirin, was also associated with a slight increase in risk of C. difficile. Proton pump inhibitors more effectively suppress gastric acid than H2 -receptor agonists.


Decreased gastric acidity, they wrote, is "a known risk factor for other infectious diarrheal illnesses such as travelers' diarrhea, salmonellosis, and cholera."


The concluded, "Acid-suppressive agents are among the most frequently prescribed medications in the United Kingdom and North America, and it is in this context that the contribution of these agents by potentially increasing the pool of susceptible hosts to the increasing rates of [C. difficile-associated disease] need to be considered and more completely characterized."


C. Difficile is usually considered a nosocomial infection, but in this analysis the researchers identified 1,233 cases among patients who had not been hospitalized in the year prior to diagnosis. Those 1,233 cases account for 74% of the 1627 cases of C. difficile identified in the General Practice Research Database.


The researchers compared cases with age-matched controls. Four hundred of the 1,233 cases were diagnosed by clinical symptoms and 833 were identified by positive toxin assay.


The mean age of patients with community-acquired C. difficile was 71 and most of the cases were women. Other factors associated with C. difficile were history of renal failure, inflammatory bowel disease, malignancy, and methicillin-resistant Staphylococcus aureus-positive.



Primary source: Journal of the American Medical Association
Source reference:
Dial, S et al. "Use of Gastric Acid-Suppressive Agents and the Risk of Community-Acquired Clostridium difficile-Associated Disease" JAMA 2005; 294:2989-2995.

http://www.medpagetoday.com/Gastroenterology/GERD/tb/2362

--------------------
Heather is the Administrator of the IBS Message Boards. Shes the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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