Acid-suppression medications and bacterial gastroenteritis: a population-based cohort study

Li Wei (Lead / Corresponding author), Lasantha Ratnayake, Gabby Phillips, Chris C. McGuigan, Steve V. Morant, Robert W. Flynn, Isla S. Mackenzie, Thomas M. MacDonald (Lead / Corresponding author)

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28 Citations (Scopus)
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Aims: To investigate whether acid suppression medicines (ASMs) increase the risk of bacterial gastroenteritis.

Methods: A population-based, propensity-score matched cohort study using a record-linkage database in Tayside, Scotland. The study consisted of 188,323 exposed to ASMs [proton pump inhibitors (PPIs) and H2 receptor antagonists (H2RA)] and 376,646 controls (a propensity-score matched cohort from the rest of population who were not exposed to ASMs) between 1999 and 2013. The main outcome measure was a positive stool test for C. difficile, Campylobacter, Salmonella, Shigella or Escherichia coli O157. The association between ASMs and risk of bacterial gastroenteritis was assessed by a Cox regression model.

Results: There were 22,705 positive test results (15,273 Clostridium difficile (toxin positive), 6,590 Campylobacter, 852 Salmonella, 129 Shigella and 193 Escherichia coli O157, not mutually exclusive) with a total of 5,729,743 person-years follow up time in Tayside, 1999-2013. The adjusted hazard ratios (HRs) for culture positive diarrhoea for the PPIs and H2RA exposed vs unexposed cohort were 2.72 [95% confidence interval (CI) 2.33, 3.17] during follow up time for samples submitted from the community and 1.28 (95% CI 1.08, 1.52) for samples submitted from hospitals. Compared with the unexposed cohort, patients in the exposed group had increased risks of C. difficile and Campylobacter [adjusted HRs of 1.70 (95% CI 1.28, 2.25), 3.71 (95% CI 3.04, 4.53) for community samples, and 1.42 (95% CI 1.17, 1.71), 4.53 (95% CI 1.75, 11.8) for hospital samples, respectively].

Conclusions: The results suggest that community prescribed ASMs were associated with increased rates of C. difficile and Campylobacter positive gastroenteritis in both the community and hospital settings.

Original languageEnglish
Pages (from-to)1298-1308
Number of pages11
JournalBritish Journal of Clinical Pharmacology
Issue number6
Early online date5 Jan 2017
Publication statusPublished - Jun 2017


  • Acid-suppression medications
  • Bacterial gastroenteritis
  • Cohort study

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)


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