Background. PPIs are one of the most commonly prescribed medications worldwide, and use has been associated with bacteria gastroenteritis. We investigated the association between PPI use, type and dose and infectious gastroenteritis hospitalization in a population-based cohort of middle-aged and older adults.
Methods. Prospective study of 38,019 concession card holders followed up over 6 years in the Sax Institute's 45 and Up Study. Data from the baseline questionnaire were linked to multiple health databases, including pharmaceutical data, hospitalization, notifiable disease and death datasets from 2006 to 2012. Associations between PPI use and gastroenteritis hospitalization were examined using Cox proportional hazards models with age as the underlying time variable, adjusted for sociodemographic and health covariates, and other medication use.
Results. Among 38,019 participants, the median age was 69.7 years and 57.3% were women. Compared to non-users, PPI current users were more likely to be older and have a higher BMI. Esomeprazole was the most frequently dispensed PPI (30.1%) followed by omeprazole (25.2%) and pantoprazole (21.4%). During follow-up there were 1982 incident hospitalizations for infectious gastroenteritis (crude rate: 12.9 per 1000 person-years, 95% CI, 12.3–13.5). The adjusted relative risk of infectious gastroenteritis hospitalization was significantly higher in current PPI users (aHR 1.4; 95% CI, 1.2–1.5) compared to non-users. Among current users, a dose-response relationship was observed between the average daily dose (DDD) dispensed per day and infectious gastroenteritis hospitalization (Ptrend < 0.001); compared to non-users, aHRs were 1.1 (95% CI, 0.9–1.3), 1.4 (95% CI, 1.3–1.6) and 1.6 (95% CI, 1.3–1.8) among participants with a dose ≤0.5 DDD/day, 0.5–1 DDD/day, and >1 DDD/day, respectively. The dose response effect was consistent when analyses were restricted to participants with a history of chronic bowel problems (Ptrend < 0.001).
Conclusion. PPI use is associated with an increased risk of infectious gastroenteritis hospitalization with increasing risks among increasing doses. Clinicians should be aware of this potential association when considering PPI therapy, and use the lowest effective dose for patients with appropriate indications.
Disclosures. All authors: No reported disclosures