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Risk of community-acquired pneumonia with outpatient proton-pump inhibitor therapy: a systematic review and meta-analysis

Lambert AA, Lam JO, Paik JJ, Ugarte-Gil C, Drummond MB, Crowell TA.
PLoS One 2015 Jun 4; 10(6):e0128004.

BACKGROUND:

Proton-pump inhibitors (PPIs) are among the most frequently prescribed medications. Community-acquired pneumonia (CAP) is a common cause of morbidity, mortality and healthcare spending. Some studies suggest an increased risk of CAP among PPI users. We conducted a systematic review and meta-analysis to determine the association between outpatient PPI therapy and risk of CAP in adults.

METHODS:

We conducted systematic searches of MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Scopus and Web of Science on February 3, 2014. Case-control studies, case-crossover, cohort studies and randomized controlled trials reporting outpatient PPI exposure and CAP diagnosis for patients ≥18 years old were eligible. Our primary outcome was the association between CAP and PPI therapy. A secondary outcome examined the risk of hospitalization for CAP and subgroup analyses evaluated the association between PPI use and CAP among patients of different age groups, by different PPI doses, and by different durations of PPI therapy.

RESULTS:

Systematic review of 33 studies was performed, of which 26 studies were included in the meta-analysis. These 26 studies included 226,769 cases of CAP among 6,351,656 participants. We observed a pooled risk of CAP with ambulatory PPI therapy of 1.49 (95% CI 1.16, 1.92; I2 99.2%). This risk was increased during the first month of therapy (OR 2.10; 95% CI 1.39, 3.16), regardless of PPI dose or patient age. PPI therapy also increased risk for hospitalization for CAP (OR 1.61; 95% CI: 1.12, 2.31).

DISCUSSION:

Outpatient PPI use is associated with a 1.5-fold increased risk of CAP, with the highest risk within the first 30 days after initiation of therapy. Providers should be aware of this risk when considering PPI use, especially in cases where alternative regimens may be available or the benefits of PPI use are uncertain.

Link to open access article: Lambert AA, et al; PLoS One. 2015 Jun 4; 10(6):e0128004.

PPI risks, Lambert

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  • What Is GERD (Gastroesophageal Reflux Disease)?
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This site is published by EndoGastric Solutions, Inc., and is intended as an information resource to help increase awareness of GERD-related disorders and the available treatment options. This site is not a substitute for medical advice from your physician. The contents of the site are for informational purposes only and are intended to be discussed with your physician. Never disregard any advice given to you by your physician or other qualified healthcare professional. Always seek the advice of a physician or other licensed healthcare professional regarding any questions you have about your medical conditions and treatments.

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  • What is GERD
    • Overview
    • GERD Symptoms: Signs of Acid Reflux Disease
    • What Causes Gastroesophageal Reflux Disease (GERD)?
    • Hiatal Hernia and the TIF procedure
    • Diagnosis of GERD: How Gastroesophageal Reflux Disease is Diagnosed
  • GERD Treatment Options
    • Overview
    • Treating GERD with Diet and Lifestyle Changes
    • Medications for GERD Treatment
    • Antireflux Surgery: Types of Fundoplication
  • TIF Procedure: Transoral Incisionless Fundoplication Surgery
    • Overview
    • Comparison of the TIF Procedure and Nissen Fundoplication
    • Is the TIF Procedure Right for You?
    • What to Expect Before, During, and After TIF Procedure
    • Clinical Results for the TIF Procedure
    • TIF Procedure Side Effects, Risks, and Complications: Safety Information For Potential Patients
    • Affording the TIF Procedure: Costs and Insurance Coverage
    • Frequently Asked Questions: TIF Surgery and the EsophyX Device to Treat GERD
  • Patient Resources
    • Patient Stories
    • Frequently Asked Questions: TIF Surgery and the EsophyX Device to Treat GERD
    • GERD-HRQL: Health Related Quality of Life Questionnaire
    • Questions for your Doctor: What to Ask About GERD Diagnosis and Treatment
    • Additional Reflux and GERD Resources
    • Glossary of Terminology
  • Blog
  • News
    • Media Coverage
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