Correlation of Proton Pump Inhibitors with Pulmonary Tuberculosis: A Case-Control Study in Taiwan.

Kao-Chi Cheng,Cheng-Li Lin,Shih-Wei Lai,Kuan-Fu Liao

doi:10.3389/fphar.2017.00481

Abstract

Background and Objectives: Although the relationship between the use of proton pump inhibitors (PPIs) and pulmonary tuberculosis (TB) in Taiwan published in 2014. Due to just only one article and not enough comprehensively, we explore this issue.Methods: We conducted a population-based case-control study to identify 9,422 subjects aged 20 years or older with newly diagnosed pulmonary TB in 2000–2013 as test cases. We then randomly selected 9,422 subjects aged 20 years or older without pulmonary TB as controls. Both cases and controls were matched in terms of sex, age, and comorbidities. Use of PPIs were defined as subjects who had had at least one prescription for these medications before the index date. No use was defined as subjects who had never had a prescription for PPIs before the index date. The odds ratio (OR) and 95% confidence interval (CI) for pulmonary TB associated with PPI use was estimated using the logistic regression model.Results: The OR of pulmonary TB was 1.31 for subjects who had used PPIs (95% CI 1.22, 1.41) compared with those with no use of the medications. Sub-analysis revealed the OR of pulmonary TB in subjects using PPI per increasing microgram was 1.25 (95% CI 1.19, 1.30).Conclusions: PPI use is associated with a 1.3-fold increase in odds of developing pulmonary TB in Taiwan. There is a dose-related response between PPI use and pulmonary TB.

Highlights

Gastric acid plays a major role in decontaminating the upper gastrointestinal tract
Previous studies have described the relationship between pump inhibitors (PPIs) use and several enteric infections, such as Salmonella enteritis and Clostridium difficile colitis (Dial et al, 2005; Rodríguez et al, 2007), including spontaneous bacterial peritonitis in severe cirrhotic patients (Bajaj et al, 2009)
Age, mean† Duration of exposure to proton pump inhibitors, mean† Ever use of proton pump inhibitors Ever use of histamine-2 receptor antagonists COMORBIDITIES Alcohol-related disease Asbestosis Chronic liver disease Chronic obstructive pulmonary disease Chronic kidney disease Diabetes mellitus Human immunodeficiency virus infection Gastrectomy Pneumoconiosis Splenectomy

Summary

Introduction

Gastric acid plays a major role in decontaminating the upper gastrointestinal tract. A review article published about 30 years ago sought to determine the relationship between gastric secretion and ingested organisms resulting in possible infection (Howden and Hunt, 1987). Proton Pump Inhibitors and Pulmonary Tuberculosis histamine 2 receptor antagonists (H2RAs) in preventing clinically important and overt upper gastrointestinal bleeding (Alhazzani et al, 2013). Several research works have indicated that, besides the gastrointestinal system, PPIs are positively associated with infections of the respiratory system, such as community- or hospital-acquired pneumonia (Gulmez et al, 2007; Sarkar et al, 2008; Jager et al, 2012). In addition to hospital- or community-acquired pneumonia, Mycobacterium tuberculosis (TB)-associated infection exerts significant burdens on the health-care systems of developing countries, including Taiwan (Hsueh et al, 2006). The relationship between the use of proton pump inhibitors (PPIs) and pulmonary tuberculosis (TB) in Taiwan published in 2014. Due to just only one article and not enough comprehensively, we explore this issue

Methods

Results

Conclusion