title: Acid-suppression medications and bacterial gastroenteritis: a population-based cohort study.
abstract: To investigate whether acid-suppression medicines (ASMs) increase the risk of bacterial gastroenteritis.
  
  
  
  A population-based, propensity-score matched cohort study using a record-linkage database in Tayside, UK. The study consisted of 188 323 exposed to ASMs (proton-pump inhibitors and histamine-2 receptor antagonists) and 376 646 controls (a propensity-score matched cohort from the rest of population who were not exposed to ASMs) between 1999 and 2013. The main outcome measure was a positive stool test for Clostridium difficile, Campylobacter, Salmonella, Shigella or Escherichia coli O157. The association between ASMs and risk of bacterial gastroenteritis was assessed by a Cox regression model.
  
  
  
  There were 22 705 positive test results (15 273 C. difficile [toxin positive], 6590 Campylobacter, 852 Salmonella, 129 Shigella and 193 E. coli O157, not mutually exclusive) with a total of 5 729 743 person-years follow up time in Tayside, 1999-2013. The adjusted hazard ratios for culture positive diarrhoea for the proton-pump inhibitors and histamine-2 receptor antagonists exposed vs. unexposed cohort were 2.72 (95% confidence interval [CI] 2.33, 3.17) during follow-up time for samples submitted from the community and 1.28 (95% CI 1.08, 1.52) for samples submitted from hospitals. Compared with the unexposed cohort, patients in the exposed group had increased risks of C. difficile and Campylobacter [adjusted hazard ratios of 1.70 (95% CI 1.28, 2.25), 3.71 (95% CI 3.04, 4.53) for community samples, and 1.42 (95% CI 1.17, 1.71), 4.53 (95% CI 1.75, 11.8) for hospital samples, respectively].
  
  
  
  The results suggest that community prescribed ASMs were associated with increased rates of C. difficile and Campylobacter positive gastroenteritis in both the community and hospital settings.
authors.affiliation: Department of Practice and Policy, School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK.
authors.forename: Li
authors.initials: L
authors.lastname: Wei
authors.affiliation: James Paget University Hospitals NHS Foundation Trust, Lowestoft Road, Gorleston-on-Sea. Norfolk, NR31 6LA, UK.
authors.forename: Lasantha
authors.initials: L
authors.lastname: Ratnayake
authors.affiliation: Medical Microbiology, Ninewells Hospital, Dundee, DD1 9SY, UK.
authors.forename: Gabby
authors.initials: G
authors.lastname: Phillips
authors.affiliation: NHS Tayside, Directorate of Public Health, King's Cross, 350 Clepington Road, Dundee, DD3 8EA, UK.
authors.forename: Chris C
authors.initials: CC
authors.lastname: McGuigan
authors.affiliation: Medicines Monitoring Unit, Division of Medical Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
authors.forename: Steve V
authors.initials: SV
authors.lastname: Morant
authors.affiliation: Medicines Monitoring Unit, Division of Medical Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Flynn
authors.affiliation: Medicines Monitoring Unit, Division of Medical Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
authors.forename: Isla S
authors.initials: IS
authors.lastname: Mackenzie
authors.affiliation: Medicines Monitoring Unit, Division of Medical Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: MacDonald
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003967:Diarrhea / Q000382:microbiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology; D006635:Histamine H2 Antagonists / Q000009:adverse effects*; D006801:Humans; D007297:Inpatients; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009853:Omeprazole / Q000009:adverse effects; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D012042:Registries; D012306:Risk; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D009853:Omeprazole
keywords: acid-suppression medications; bacterial gastroenteritis; cohort study