PPI and community acquired pneumonia

Previous observational studies have found that PPI's are associated with an increased risk of hospitalisation for community-acquired pneumonia (HCAP). However, these studies are confounded by gastroesophageal reflux disease and protopathic bias. Such confounders could be overcome by studying patients prescribed PPI's as prophylaxis for NSAIDs. In this issue of Gut, Filion et al performed one of the largest studies ever on this subject. They formed eight restricted cohorts of new users of NSAIDs, aged ≥40 years, using a common protocol in eight databases (Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia, US MarketScan and the UK's General Practice Research Database (GPRD)). After adjustment, PPIs were not associated with an increased risk of HCAP (OR=1.05; 95% CI 0.89 to 1.25). Histamine-2 receptor antagonists yielded similar results (OR=0.95, 95% CI 0.75 to 1.21) suggesting a lack of dose-response relationship between potency of gastric acid suppression and the risk of HCAP (table 1). The authors conclude that concerns regarding HCAP should not influence prescribing of gastric acid-suppressing medications⇓.