title: Proton Pump Inhibitors versus Histamine-2 Receptor Antagonists and Risk of Pneumonia in Patients with Acute Stroke.
abstract: BACKGROUND
  Pneumonia is a serious complication of stroke. Several studies have indicated that certain gastric acid suppressants may be associated with an increased risk of pneumonia in hospitalized patients. However, the association between type of acid suppressant and pneumonia in acute stroke patients remains controversial. The purpose of this study was to clarify the association between the type of acid suppressant and the occurrence of pneumonia in acute stroke patients.
  
  
  METHODS
  This retrospective observational study used data from the national Japanese Diagnosis Procedure Combination inpatient database. We identified patients who were admitted to acute-care hospitals with stroke. The outcome was the occurrence of pneumonia assessed using diagnostic codes. We performed propensity score-matched analysis to compare the outcome between proton pump inhibitor (PPI) users and histamine-2 receptor antagonist (H2RA) users.
  
  
  RESULTS
  A total of 77,890 stroke patients were identified, of whom 63,980 were prescribed H2RAs and 13,910 were prescribed PPIs. Overall, 1490 (10.7%) of the patients receiving PPIs and 6401 (10.0%) of the patients receiving H2RAs developed pneumonia after stroke. After propensity score matching, the incidence of pneumonia in PPI users was not different from that in H2RA users (odds ratio: 1.10, 95% confidence interval: .99-1.21).
  
  
  CONCLUSIONS
  No significant difference in the incidence of pneumonia was seen between users of PPIs and H2RAs after acute stroke.
authors: Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan. Electronic address: momosakiryo@gmail.com.
authors: Ryo
authors: R
authors: Momosaki
authors: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors: Hideo
authors: H
authors: Yasunaga
authors: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors: Hiroki
authors: H
authors: Matsui
authors: Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
authors: Kiyohide
authors: K
authors: Fushimi
authors: Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
authors: Masahiro
authors: M
authors: Abo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D016208:Databases, Factual; D004185:Disability Evaluation; D005260:Female; D006635:Histamine H2 Antagonists / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology*; D057216:Propensity Score; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors
keywords: Pneumonia; acute stroke; histamine-2 receptor antagonists; proton pump inhibitors