title: Use of Proton Pump Inhibitors and the Risk of Hospitalization for Infectious Gastroenteritis.
abstract: BACKGROUND
  To quantify the association between PPI use, type and dose and infectious gastroenteritis hospitalization in a population-based cohort of middle-aged and older adults.
  
  
  METHODS
  Prospective study of 38,019 concession card holders followed up over 6 years in the Sax Institute's 45 and Up Study. Data from the baseline questionnaire were linked to prescription medication, hospitalization, notifiable disease, cancer registry and death datasets from 2006-2012. Associations between PPI use and gastroenteritis hospitalization were examined using Cox regressions with age as the underlying time variable.
  
  
  RESULTS
  Among 38,019 participants, the median age was 69.7 years, and 57.3% were women. Compared to non-users, current PPI users were more likely to be older, and have a higher BMI. During follow-up there were 1,982 incident gastroenteritis hospitalizations (crude rate: 12.9 per 1000 person-years, 95% CI: 12.3-13.5). PPI use was significantly associated with infectious gastroenteritis hospitalization (aHR 1.4, 95% CI: 1.2-1.5). Among current users, a dose-response relationship was observed between the average daily dose (DDD) dispensed per day and infectious gastroenteritis hospitalization (Ptrend<0.001). We also observed higher rates of infectious gastroenteritis hospitalization and greater PPI use among participants with a history of chronic bowel problems (aHR 2.2, 95% CI: 1.9-2.5). There was no difference in risk by type of PPI. Recent use of H2 receptors was not associated with gastroenteritis hospitalization.
  
  
  CONCLUSIONS
  PPI use is associated with an increased risk of infectious gastroenteritis hospitalization. Clinicians should be aware of this risk when considering PPI therapy.
authors.affiliation: The Australian National University, Canberra, ACT, Australia.
authors.forename: Yingxi
authors.identifier: http://orcid.org/0000-0002-3565-1052
authors.initials: Y
authors.lastname: Chen
authors.affiliation: University of New South Wales, Sydney, NSW, Australia.
authors.forename: Bette
authors.initials: B
authors.lastname: Liu
authors.affiliation: The Australian National University, Canberra, ACT, Australia.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Glass
authors.affiliation: The Australian National University, Canberra, ACT, Australia.
authors.forename: Wei
authors.initials: W
authors.lastname: Du
authors.affiliation: The Australian National University, Canberra, ACT, Australia.|Sax Institute, Sydney, NSW, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Banks
authors.affiliation: The Australian National University, Canberra, ACT, Australia.
authors.forename: Martyn
authors.initials: M
authors.lastname: Kirk
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D001424:Bacterial Infections / Q000139:chemically induced / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005759:Gastroenteritis / Q000139:chemically induced / Q000453:epidemiology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D054328:Proton Pump Inhibitors