Abstract
BackgroundThe acid-suppressive agents have been linked with an increased risk of infectious disease. The relationship between these drugs and Mycobacterium Tuberculosis (TB) was not been reported.MethodsWe conducted a case–control study using data from National Health Insurance research database of Taiwan. From 1996 till 2008, and 6541 cases were defined as TB infection/activation (ICD-9 coding plus prescription two of four first-line anti-TB regimen for at least one month). Control subjects who were matched to the TB cases by age and sex were selected with 10:1 ratio. Medical records including acid-suppressive agent prescription and comorbidity, and socioeconomic status were analyzed.ResultsTB infection/activation was more frequent to comorbidity with chronic diseases, alcohol abuse, malignancy, immune deficient/suppression status and acid-related disease (peptic ulcer, reflux esophagitis). Among the TB cases, there was higher exposure record to acid-suppressive agents within 3 months before TB index date (OR 2.43(2.06-2.88) and 1.90 (1.68-2.14) for proton pump inhibitor (PPI) and histamine 2 receptor antagonist (H2RA) respectively). After adjusting confounding factors, PPIs prescription 3 months before TB index date had an association of TB infection/activation (adjusted OR 1.63(1.61-1.63)). Similar result was found in H2RA user (adjusted OR 1.51(1.50-1.52)). The association of acid-suppressive agents in TB infection/activation was fade gradually when the drug prescription period extended.ConclusionsRecent prescription of acid-suppressive agent seems to associate the TB infection/activation. In the society where TB was prevalent, evaluation of pulmonary TB before prescription of PPI or H2RA is warranted.
Highlights
The acid-suppressive agents have been linked with an increased risk of infectious disease
Following the widespread use of acid-suppressive agents [1,2,3], which are the mainstream of treatment in peptic ulcer disease and acid reflux associated esophageal disease, its eliminating acid barrier effect had been implied the association with infectious disease
The disease used to be uncommon in developed countries, but it has re-emerged in the Western countries as a result of the acquired immunodeficiency syndrome (AIDS) epidemic therein as well as the influx of immigrants from developing countries [12,13]
Summary
The acid-suppressive agents have been linked with an increased risk of infectious disease. The relationship between these drugs and Mycobacterium Tuberculosis (TB) was not been reported. Gastric acid plays an important role in decontamination of upper gastrointestinal tract. Following the widespread use of acid-suppressive agents [1,2,3], which are the mainstream of treatment in peptic ulcer disease and acid reflux associated esophageal disease, its eliminating acid barrier effect had been implied the association with infectious disease. [14,15] But, the role of gastric acid in TB infection was still unknown. There was no large study which examined the association between acid-suppressive agents and TB. We utilized the database from Taiwan National Health Insurance (NHI) to evaluate its correlation under a population-based, case–control analysis
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