Rochester, MN—More questions about the safety of gastric acid suppression medications were raised in a recent study.

A report posted online by JAMA Internal Medicine suggests that use of the drugs—including proton pump inhibitors and histamine 2 blockers, both prescribed and OTC raise the risk of for recurrent Clostridium difficile infection (CDI).

“In our study, we found that use of gastric acid suppression medications are associated with a statistically significant increased risk of development of recurrent C-diff in patients with a prior episode of C. diff,” explained senior author Sahil Khanna, MBBS, a gastroenterologist at Mayo Clinic.

For the study, the researchers conducted a systematic review and meta-analysis of 16 studies involving 7,703 patients with CDI, of whom 1,525 developed recurrent infections. Results indicate that that the rate of recurrent CD in patients with gastric suppression was 22.1%, compared to 17.3% in patients without gastric acid suppression.

Background information in the article notes that recurrent CDI after a primary infection is a major problem, with the risk being as high as 50% to 60% after three or more infections. Commonly accepted risk factors for recurrent CDI include older age, concomitant antibiotic use, and comorbid conditions.

Study authors point out, however, that up to 50% of patients with CDI are using concomitant gastric acid suppressants, adding, “Patients with primary CDI infection are rarely re-evaluated after the CDI episode to assess the necessity of these and other medications.”

One of the reasons for their meta-analysis was that data on the association between gastric acid suppression and recurrent CDI has been conflicting, they explained.

While noting that some variables were not considered in the study, such as the underlying reason why the gastric acid suppressant was needed, Khanna advised, “It may be reasonable to re-evaluate the need for these medications in patients with C-diff.”

Another recent study looking at a large population found that intestinal infections with C difficile and Campylobacter bacteria increased for patients using commonly prescribed acid-suppression medications.

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