Proton pump inhibitors and the risk of hospitalisation for community-acquired pneumonia (Q10-D1)

Proton pump inhibitors and the risk of hospitalisation for community-acquired pneumonia (Q10-D1)

Q10-D1

Overview

What is the issue?
  • PPIs are often used to treat the symptoms of gastroesophageal reflux disease (GERD) and peptic ulcer disease. PPIs can also be prescribed to prevent upper gastrointestinal complications that can occur with the use of non-steroidal anti-inflammatory drugs (NSAIDs).
  • Previous studies suggest that PPI use increases the risk of community-acquired pneumonia; however, studies conducted in this area have had important limitations.
What was the aim of the study?
  • This study examined the risk of hospitalization for community-acquired pneumonia (HCAP) in people using PPIs.
How was the study conducted?
  • Our investigators conducted eight population-based cohort studies with health records of over 4 million patients, aged 40 years or older, from six Canadian provinces and two international databases. The study was restricted to patients receiving NSAIDs, as they are less likely to have GERD. GERD is associated with respiratory problems; it must be removed as a confounder (or competing cause).
  • Intention-to-treat analyses were performed in each cohort to compare the 6-month incidence of HCAP in patients who were prescribed a PPI to that in patients who were not. Site-specific results were then pooled using standard meta-analytic techniques.
What did the study find?
  • Our investigators conducted eight population-based cohort studies with health records of over 4 million patients, aged 40 years or older, from six Canadian provinces and two international databases. The study was restricted to patients receiving NSAIDs, as they are less likely to have GERD. GERD is associated with respiratory problems; it must be removed as a confounder (or competing cause).
  • Intention-to-treat analyses were performed in each cohort to compare the 6-month incidence of HCAP in patients who were prescribed a PPI to that in patients who were not. Site-specific results were then pooled using standard meta-analytic techniques.
Implications
  • Physicians can reassure their patients that using proton pump inhibitors will not increase their chances of getting community-acquired pneumonia.
Key message
  • Proton pump inhibitors (PPIs) do not increase the risk of hospitalization for community-acquired pneumonia.

Manuscripts

Filion KB. Proton pump inhibitors and community acquired pneumonia: The observed link is probably due to protopathic bias and confounding by indication. BMJ 2016 Nov 17; 355:i6041. [Invited Editorial]

Ayele HT, Dormuth CR, Filion KB. Long-term use of proton pump inhibitors and community-acquired pneumonia: adverse effect or bias?. JAGS. 2018 Dec;66(12):2427-2428.

Filion KB, Chateau D, Targownik LE, Gershon A, Durand M, Tamim H, Teare GF, Ravani P, Ernst P, Dormuth CR, and the CNODES Investigators. Proton Pump Inhibitors and the Risk of Hospitalization for Community-Acquired Pneumonia: Replicated Cohort Studies with Meta-Analysis. Gut. 2014 Apr;63(4):552-8.

Presentations

Project Team

Project Lead
Kristian Filion PhD
Methods Lead
Dan Chateau PhD
Site Investigator
Gary Teare DVM, MSc, PhD
Saskatchewan
Site Investigator
Yola Moride PHD, FISPE
Quebec
Site Investigator
Andrea Gershon MSc, MD
Ontario
Site Investigator
Hala Tamim PhD
Atlantic
Site Investigator
Colin R. Dormuth ScD
MarketScan
Site Investigator
Laura Targownik
Manitoba
Site Investigator
Pierre Ernst MD, MSc, FRCPC
CPRD
Site Investigator
Pietro Ravani PhD
Alberta
Analyst
Wenbin Li
Saskatchewan
Analyst
Thierry Ducruet
Quebec
Analyst
Fangyun Wu MSc
Ontario
Analyst
Steve Doucette MSc
Atlantic
Analyst
Yan Wang MSc
Atlantic
Analyst
Greg Carney BSc, PhD
MarketScan
Analyst
Matthew Dahl BSc
Manitoba
Analyst
Rick Chin
Alberta
Collaborator
Madeleine Durand MD, MSc, FRCPC
Quebec
Collaborator
Michael Paterson MSc
Ontario
Collaborator
Tarita Miller BSc
MarketScan
Collaborator
Brenda Hemmelgarn MD, PhD, FRCPC
Alberta
Collaborator
Lauren Bresee PhD
Alberta