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Oct. 27, 2004 — Individuals who use gastric acid-suppressive medications may
be at an elevated risk of developing community-acquired pneumonia, according to
an article in the October 27 issue of the Journal of the American Medical
Association.
According to background information in the article, 20
to 40 percent of the general population experiences at least one episode of
indigestion or gastroesophageal reflux disease (GERD, a backflow of acid from
the stomach into the swallowing tube or esophagus) and five percent consult a
general practitioner for their ailment. In primary care, a common way to treat
these symptoms is to reduce gastric (stomach) acid secretions with the use of
acid-suppressive drugs. However, these medications can increase vulnerability to
infections, as stomach acidity is a major defense mechanism against ingested
pathogens.
Robert J.F. Laheij, Ph.D., from the University Medical Center
St. Radboud, Nijmegen, Netherlands, and colleagues studied pneumonia rates of
both patients who did and did not use acid-suppressing medication. Patients were
identified from the Integrated Primary Care Information (IPCI) database between
January 1995 and December 2002. The study population included 364,683
individuals from the Netherlands who developed 5,551 cases of pneumonia for the
first time.
The researchers found that current use of all
acid-suppressive drugs was associated with a 27 percent increase in the risk of
pneumonia, with higher risks for specific classes of acid-suppressive drugs
(such as proton pump inhibitors or H2-receptor antagonist drugs).
“The
effectiveness of acid-suppressive drugs in the treatment of upper
gastrointestinal tract symptoms is excellent. Acid-suppressive drugs
nevertheless seem to have some significant drawbacks,” write the authors.
“Persons using acid-suppressive drugs more often develop a community-acquired
pneumonia compared with those who do not use acid-suppressive drugs, which is in
general not a problem because the risk for developing pneumonia is low. The
increased risk for pneumonia is a problem for patients who are at increased risk
for infection, especially because community-acquired pneumonia is potentially
dangerous.”
Editorial: Acid Suppression and Pneumonia — A Clinical
Indication for Rational Prescribing
In an accompanying editorial,
James C. Gregor, M.D., from the University of Western Ontario, London, Ontario,
Canada, examines the effectiveness and risks of acid-suppressive
drugs.
“Because of their efficacy and impressive safety profile that has
far exceeded original expectations, acid-suppressing drugs have consistently
been among the most widely prescribed medications worldwide, with almost $13
billion in sales in 1998 and an annual growth rate of three percent.”
Dr.
Gregor states that these drugs are now widely used to treat a number of
gastrointestinal diseases. “As the indications for these drugs expand further
and as the population ages, the number of patient-years of exposure will
continue to increase and any unrecognized complications will become of greater
importance.”
He concludes by saying: “If acid suppression causes some
cases of pneumonia, it is reassuring that the risk is relatively small and that
the complication in most cases is usually amenable to therapy. However, no
medication is without potential adverse effects. Concerns for patient safety
should guide initial prescribing and perhaps more importantly, chronic use of
even the most apparently benign drug.”
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