Acid Blocking proton pump inhibitor drugs and diarrhea

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Clostridium difficile-associated diarrhea usually occurs as a result of antibiotic use and can be potentially life threatening. The role of body defenses especially gastric acid secretion as a risk factor has not been fully elucidated.

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Proton pump inhibitors (PPI: Nexium, Prevacid, Protonix, Prilosec, Aciphex) are frequently prescribed for acid reflux, peptic ulcers etc. They act by causing suppression of gastric acid secretion which is an important component of defense mechanism against infections.

Dr. Yearsley and colleagues studied the impact of acid blockade by chronic PPI therapy as a risk factor for development of C. difficile diarrhea and published their findings in the journal Alimentary Pharmacology Therapeutics (August 2006).

Study

These investigators performed a case controlled study with 155 C. difficile diarrhea patients.

Results

• They found that among the C. difficile-associated diarrhea group, 41% had received acid suppression with PPIs 26% of controls.
• This translates into the fact that chronic PPI therapy almost doubles the risk of C. difficile diarrhea.

Comments

Several other studies and authors including Dr. Minocha's published articles in peer-reviewed literature have since come up with similar conclusions.  

Is It Leaky Gut or Leaky Gut Syndrome? 

Take home message: Since antibiotics are the predominant cause of C. difficile associated diarrhea, the risk of concurrent therapy with PPI plus antibiotics should be carefully weighed.

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