SAN ANTONIO (EGMN) – Proton pump inhibitor use was associated with an 80% increase in the risk of Clostridium difficile–associated diarrhea, based on data from a meta-analysis of 21 studies.

Proton pump inhibitors (PPIs) are generally considered safe, resulting in some degree of indiscriminate use, said Dr. Sailajah Janarthanan of Wayne State University in Detroit. PPIs have faced scrutiny for a possible association with C. difficile–associated diarrhea (CDAD), but results from previous studies have yielded mixed results, Dr. Janarthanan said.

“Given the millions of individuals on PPIs, even a slight increase in the risk of CDAD conferred by these drugs will have major public health implications,” she emphasized.

To explore the relationship between PPIs and CDAD, Dr. Janarthanan and her colleagues looked at data from 21 peer-reviewed published studies. The 7 cohort studies and 14 case-control studies included 133,054 individuals.

Overall, there was a significant increase in the risk of CDAD in patients taking PPIs (risk estimate, 1.80). The risk estimate in the case-control studies was 1.55 and in the cohort studies 2.07. The CDAD risk was significantly higher for patients taking PPIs whether the types of studies were considered separately or as a whole.

C. difficile represents an escalating threat to public health, and CDAD cost the United States an estimated $3 billion in 2005, Dr. Janarthanan said at the annual meeting of the American College of Gastroenterology.

The results of the studies reviewed by Dr. Janarthanan and her associates were limited by the lack of randomized, controlled trials, she noted, and the impact of PPIs on CDAD remains controversial.

“Indiscriminate use of PPIs without proper indication should be discouraged,” she said. “There is a real-time need for guidelines on the use of PPIs, especially in hospitals.”

Dr. Janarthanan reported having no financial conflicts of interest.

Copyright (c) 2010 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

圣安东尼奥(EGMN)——美国胃肠病学会年会上报告的一项荟萃分析显示，质子泵抑制剂(PPI)的应用与艰难梭菌相关腹泻(CDAD)风险增加80%有关。

本分析的对象为21项已发表的研究，其中7项为队列研究，14项为病例对照研究，共涉及133,054名受试者。

总体分析发现，PPI服用者的CDAD风险显著增加(风险估计值1.80)。根据研究类型进行单独分析亦发现PPI服用者的CDAD风险显著增加，风险估计值在病例对照研究和队列研究分别为1.55和2.07。

本分析的局限性在于未纳入随机对照研究。

研究者表示，PPI具有良好安全性，这导致其在一定程度上被滥用，因此有必要即时出台PPI临床应用指南。

研究者声明无经济利益冲突。

一项分析指出，质子泵抑制剂的应用与艰难梭菌相关腹泻风险增加80%有关(感谢照片提供者，来自美国CDC的Gilda Jones博士)。

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