Format

Send to

Choose Destination
See comment in PubMed Commons below
Gut. 2014 Apr;63(4):552-8. doi: 10.1136/gutjnl-2013-304738. Epub 2013 Jul 15.

Proton pump inhibitors and the risk of hospitalisation for community-acquired pneumonia: replicated cohort studies with meta-analysis.

Author information

1
Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, , Montreal, Quebec, Canada.

Abstract

OBJECTIVE:

Previous observational studies suggest that the use of proton pump inhibitors (PPIs) may increase the risk of hospitalisation for community-acquired pneumonia (HCAP). However, the potential presence of confounding and protopathic biases limits the conclusions that can be drawn from these studies. Our objective was, therefore, to examine the risk of HCAP with PPIs prescribed prophylactically in new users of non-steroidal anti-inflammatory drugs (NSAIDs).

DESIGN:

We formed eight restricted cohorts of new users of NSAIDs, aged ≥40 years, using a common protocol in eight databases (Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia, US MarketScan and the UK's General Practice Research Database (GPRD)). This specific patient population was studied to minimise bias due to unmeasured confounders. High-dimensional propensity scores were used to estimate site-specific adjusted ORs (aORs) for HCAP at 6 months in PPI patients compared with unexposed patients. Fixed-effects meta-analytic models were used to estimate overall effects across databases.

RESULTS:

Of the 4,238,504 new users of NSAIDs, 2.3% also started a PPI. The cumulative 6-month incidence of HCAP was 0.17% among patients prescribed PPIs and 0.12% in unexposed patients. After adjustment, PPIs were not associated with an increased risk of HCAP (aOR=1.05; 95% CI 0.89 to 1.25). Histamine-2 receptor antagonists yielded similar results (aOR=0.95, 95% CI 0.75 to 1.21).

CONCLUSIONS:

Our study does not support the proposition of a pharmacological effect of gastric acid suppressors on the risk of HCAP.

KEYWORDS:

Epidemiology; Gastroesophageal Reflux Disease; Meta-Analysis; Proton Pump Inhibition

PMID:
23856153
PMCID:
PMC3963530
DOI:
10.1136/gutjnl-2013-304738
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Support Center