PPI use increases risk of viral gastroenteritis, finds JAMA Study

France: Proton pump inhibitors are the most widely used drugs to reduce the production of stomach acid. Taking Proton pump inhibitors might give you a viral intestinal infection, suggests a recent study published in the journal JAMA Network Open.

According to the study, continuous use of PPIs (proton pump inhibitors) -- most widely used drugs to reduce the production of stomach acid -- was associated with an increased risk of developing acute gastroenteritis (AGE), a common intestinal infection, during periods of highest circulation of enteric viruses. PPIs nearly doubled people's risk for developing an intestinal viral infection -- particularly in those 45 years of age and older.

However, the overall risk for infection remains small with only 1.3 per cent of those using prescription PPIs diagnosed with acute gastroenteritis.

PPIs, although considered globally safe, some observational studies associated their long-term use such as osteoporotic-related fractures, vitamin B12 deficiency, kidney disease or infections, particularly digestive tract and pulmonary infections. Several studies have linked PPI use with bacterial enteric infection. The suggested mechanism behind this may be that -- by reducing the hydrochloric acid secretion by the stomach, PPIs promote the growth of gastrointestinal microflora, increase bacterial translocation, affect the gastrointestinal microbiome, and weaken the immune system.

Read Also: Long term PPI use may increase risk of gastric cancer

The association between continuous PPI use and acute gastroenteritis caused by enteric viruses has been less studied. Ana-Maria Vilcu, Sorbonne Université, Paris, France, and colleagues conducted the study to investigate the association between continuous PPI therapy and AGE occurrence during winter epidemic periods when the circulation of enteric viruses is the highest.

The researchers compared each person exposed to continuous prescription PPI therapy during the 2015-16 winter season to three unexposed persons, matched based on age and gender using a drug-dispensing database covering community pharmacies in France. The database included pharmacy records for roughly 30 per cent of the French population.

Overall, 233,596 patients were identified who received continuous prescription PPI antacid therapy.

Read Also: Proton pump inhibitor use may lead to hepatic encephalopathy, death in cirrhosis patients

Key findings of the study include:

• At least one acute gastroenteritis epidemic episode was confirmed in 3,131, or 1.3 per cent, of the people on continuous PPI therapy, while just 4,327 of the 626,887 who were not on continuous treatment, or 0.7 per cent, developed an intestinal infection.


• The risk for infection was generally higher for those between 45 and 64 years of age, as well as for those 65 years of age and older.


• People in these age groups taking antacids continuously were more than twice as likely to develop an infection.

"These findings support the hypothesis that PPI use is associated with an increased risk of enteric viral infections and motivate the need for further studies to confirm this association and investigate the pathophysiological mechanisms," concluded the authors.

The study, "Association Between Acute Gastroenteritis and Continuous Use of Proton Pump Inhibitors During Winter Periods of Highest Circulation of Enteric Viruses," is published in the JAMA Network Open journal.

DOI: 10.1001/jamanetworkopen.2019.16205