Skip navigation

Gastric acid suppression and pneumonia

Clinical bottom line

We can expect 1 case of community-acquired pneumonia for every 226 patients treated with proton pump inhibitors and every 508 treated with histamine antagonists.


Reference

RJF Laheij et al. Risj of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA 2004 292: 1955-1960.

Study

A general practice database in Holland was used to collect electronic patient records from about 150 Dutch general practitioners, with about 500,000 patients. The time scale was 1995-2002, eight years in total.

The first indication of pneumonia for each individual was identified, and medical records reviewed. To be included, pneumonia had to be proven by chest X-ray or sputum culture (certyain diagnosis) or respiratory symptoms (probable). Cases caused by aspiration were excluded.

Results

There were 5551 first occasions of confirmed pneumonia. In patients exposed to gastric suppressing drugs, there were 185 cases of first pneumonia. The incidence rate was:

In a nested case-control study of 475 cases and 4690 controls, significant associations were found for increased presence of diabtes, heart failure, COPD, stomach cancer, lung cancer, and use of immunosuppressants in cases over controls (Table 1).

Table 1: Clinical conditions in cases and controls

Clinical condition Cases (%) Controls (%) Odds ratio (95%CI)
COPD
41
19
3.0 (2.5 to 3.7)
Heart failure
20
9
2.7 (2.1 to 3.6)
Diabetes
13
9
1.5 (1.1 to 2.0)
Immunosuppressant
8.4
2.5
3.6 (2.5 to 5.2)
Lung cancer
2.7
0.6
4.4 (2.3 to 8.5)
Stomach cancer
0.6
0.4
1.7 (0.5 to 5.8)

Examination of data for individual drugs, duration of use, or dose was limited because of limitations of numbers for the various subcategories. The attributable risk was about 40%, so that 1 case per 100 person years is attributable to PPI or H2A use. Adjusted to duration of use, this was about 1 case of community-acquired pneumonia for every 226 patients treated with PPIs and 508 treated with H2As.

Comment

This was an unusually detailed observational study providing useful information about safety of commonly used drugs.