Current Proton Pump Inhibitors Research Articles

Association Between the Use of Proton Pump Inhibitors and Severe Clinical Outcomes in COVID-19 Patients: A Retrospective Observational Study.

Background Proton pump inhibitors (PPIs) increase the risk of pneumonia secondary to PPI-induced hypochlorhydria. We aim to investigate the association between PPI and disease severity in coronavirus disease 2019 (COVID-19)-positive patients and the risk of hospitalizations in Muscat, Oman. Methodology COVID-19-positive patients aged 18 years and above at the time of diagnosis were included in this retrospective observational study. The details of the patients were retrieved from the electronic health records of the Al Shifa Hospital Information Management System and Tarassud. The composite primary endpoint was COVID-19 admission to a government tertiary hospital ward or intensive care within 14 days of diagnosis. Results A total of 506 COVID-19-positive patients were identified during the specified period. The mean age was 44 ± 15 years. The majority of the patients were Omani, and a female preponderance was observed. Overall, 104 (20.4%) patients were current PPI users. Admission due to COVID-19 was significantly associated with the presence of comorbid conditions such as diabetes mellitus (p = 0.001), hypertension (p = 0.001), and chronic kidney disease (p < 0.001). However, current PPI use (p = 0.140) was not significantly associated with an increased risk of hospitalization. Conclusions This data suggests that the use of PPIs during COVID-19 infection did not increase the risk of severe COVID-19 infection and poor outcomes leading to hospitalization in Muscat, Oman. However, the presence of other medical comorbidities, such as diabetes and hypertension, was associated with a higher risk of adverse clinical symptoms that resulted in hospitalization.

Proton Pump Inhibitor Usage in Urban vs. Rural Intensive Care Units: A Narrative Review of Implications for Standardization of Care.

Intensive care unit (ICU) patients frequently require and benefit from stress ulcer prophylaxis (SUP) using proton pump inhibitors (PPIs). Despite recognized benefits, PPIs are overutilized in patients who do not have high-risk factors predisposing them to clinically significant gastrointestinal bleeding (CSGIB), including mechanical ventilation and coagulopathy. This overuse increases the risk of adverse effects associated with PPIs. Several urban healthcare systems have created educational initiatives aimed at reducing PPI usage in patients who do not meet recommendations or who are outside the period for serious risk of CSGIB. However, there was no available literature exploring PPI use or educational trends in rural hospitals. This situation presents an opportunity to investigate the disparities in PPI use between rural and urban healthcare settings. This narrative review aimed to assess current data on PPI usage in both urban and rural critical care environments, and to appraise existing practices, ultimately identifying gaps in current literature and informing future guidelines. With these evaluations, this review intended to provide a comprehensive overview of current PPI prescribing practices in the ICU and improve patient care across diverse healthcare settings.

Proton Pump Inhibitors and Risk of COVID-19 Infection in Children

To evaluate the influence of proton pump inhibitor (PPI) use on COVID-19 susceptibility and severity in children. This retrospective, case-control study included all children ≤21years undergoing COVID-19 polymerase chain reaction testing at a tertiary children's hospital between March 2020 and January 2023. The main exposure was PPI usage. The primary outcome was COVID-19 infection. The secondary outcome was COVID-19 hospitalization. Log-binomial regressions were used to examine associations between PPI use and these outcomes. 116 209 patients age 8.5±6.2years underwent 234 867 COVID-19 tests. Current PPI use was associated with a decreased risk of COVID-19 test positivity compared with PPI nonuse [RR 0.85 (95% CI 0.76, 0.94), P=.002]; however, there was a significant interaction with time of testing, and an effect of PPIs was no longer seen in the final months of the study following lessening of COVID-19 precautions [RR 1.04 (95% CI 0.0.80, 1.36), P=.77]. PPI use was not associated with risk of hospitalization in patients positive for COVID-19 after adjusting for other hospitalization risk factors [RR 0.85 (95% CI 0.64, 1.13), P=.26]. We did not find an association between PPI use and increased COVID-19 susceptibility or severity in this pediatric sample. These results provide reassuring evidence that PPIs may not worsen COVID-19 outcomes in children.

Use of proton pump inhibitors is associated with increased risk of out-of-hospital cardiac arrest in the general population: a nested case-control study.

Proton pump inhibitors (PPIs) impair cardiac repolarization, prolong the QT interval, and may potentially be pro-arrhythmic. However, the risk of out-of-hospital cardiac arrest (OHCA) is scarcely investigated. We studied whether past or current PPI use is associated with OHCA in the general population. We conducted a nationwide nested case-control study with OHCA-cases of presumed cardiac causes and age/sex/OHCA-date-matched non-OHCA-controls from the general population. Exposure to PPI was categorized into three mutually exclusive groups of current-, past-, and non-use. Conditional logistic regression analyses with adjustments for risk factors of OHCA were used to calculate the odds ratio (OR) of OHCA comparing PPI use with non-users. We identified 46 578 OHCA cases and 232 890 matched non-OHCA controls (mean: 71 years, 68.8% men). PPI was used by 8769 OHCA-cases and 21 898 non-OHCA controls, and current use of PPI was associated with increased odds of OHCA compared with non-users [OR: 1.32 (95% CI: 1.28-1.37)], while past use conferred no increase in the odds of OHCA [OR: 1.01 (95% CI: 0.98-1.04)]. This increased odds of OHCA occurred in both sexes. Finally, the ORs remained elevated when we repeated the analyses in individuals without registered ischaemic heart disease [OR: 1.36 (95% CI: 1.31-1.41)], without heart failure [OR: 1.33 (95% CI: 1.29-1.38)], or without any cardiovascular comorbidities [OR: 1.84 (95% CI: 1.70-2.00)]. Also, the OR remained elevated when H2-antagonists served as the reference group [OR: 1.28 (95% CI: 1.11-1.47)]. PPI use is associated with an increased risk of OHCA in the general population. Considering the widespread use of PPIs, this study raises concerns and the need for awareness to balance the benefit and risk of treatment.

Association between the Use of Proton Pump Inhibitors and Cardiovascular Diseases: A Nested Case-Control Study Using a National Health Screening Cohort.

We investigated the association of proton pump inhibitor (PPI) use with the risk of stroke and ischemic heart disease (IHD). The Korean National Health Insurance Service-Health Screening cohort from 2002 to 2003, the participants of which were followed up until 2019, was used. In study I, 45,905 participants who were diagnosed with stroke were matched with 91,810 control I participants. The history of PPI medication was examined. In study II, 40,928 participants who were diagnosed with IHD were matched with 81,856 control II participants. In both study I and study II, the previous history of PPI medication was examined. A propensity score overlap-weighted multivariable logistic regression analysis was conducted to estimate the overlap-weighted odds ratios (ORs) of PPI use for stroke (study I) and IHD (study II). Current PPI use was linked with higher odds for stroke in study I. The odds for stroke were higher in groups with a longer duration of PPI use (OR = 0.96 [95% CI = 0.92-1.00] < 1.55 [1.50-1.61] < 1.62 [1.57-1.68] for < 30 days, 30 to 180 days, and ≥180 days of PPI use). Previous PPI use was linked with higher odds for IHD in study II. The odds for stroke were higher in groups with a longer duration of PPI use (OR = 1.13 [95% CI = 1.08-1.18] < 2.12 [2.04-2.21] < 2.60 [2.51-2.69] for <30 days, 30 to 180 days, and ≥180 days of PPI use). Current PPI medication is associated with a high risk of stroke and IHD. A longer duration of PPI medication was related to a higher risk of stroke and IHD. However, a prior history of PPI medication was not linked with a high risk of stroke or IHD.

Proton Pump Inhibitors and Likelihood of Colorectal Cancer in the Korean Population: Insights from a Nested Case–Control Study Using National Health Insurance Data

The potential connection between proton pump inhibitors (PPIs) and colorectal cancer (CRC) risk remains unclear, with specific ethnic genetic backgrounds playing a role in PPI-induced adverse effects. In this nested case–control study, we investigated the risk of CRC in relation to preceding PPI use and the duration of use using data from the Korean National Health Insurance Service–National Sample Cohort database, including 9374 incident CRC patients and 37,496 controls. To assess the impact of preceding PPI exposure (past vs. current) and use duration (days: &lt;30, 30–90, and ≥90) on incident CRC, we conducted propensity score overlap-weighted multivariate logistic regression analyses, adjusted for confounding factors. Our findings revealed that past and current PPI users had an increased likelihood of developing CRC. Regardless of duration, individuals who used PPIs also had higher odds of developing CRC. Subgroup analyses revealed that CRC occurrence increased independent of history or duration of prior PPI use, consistent across various factors such as age, sex, income level, and residential area. These findings suggest that PPI use, regardless of past or present use and duration of use, may be related to an increased risk of developing CRC in the Korean population.

Cumulative Use of Proton Pump Inhibitors and Risk of Dementia: The Atherosclerosis Risk in Communities Study.

Studies on the association between proton pump inhibitor (PPI) use and dementia report mixed results and do not examine the impact of cumulative PPI use. We evaluated the associations between current and cumulative PPI use and risk of incident dementia in the Atherosclerosis Risk in Communities (ARIC) Study. These analyses used participants from a community-based cohort (ARIC) from the time of enrollment (1987-1989) through 2017. PPI use was assessed through visual medication inventory at clinic visits 1 (1987-1989) to 5 (2011-2013) and reported annually in study phone calls (2006-2011). This study uses ARIC visit 5 as baseline because this was the first visit in which PPI use was common. PPI use was examined 2 ways: current use at visit 5 and duration of use before visit 5 (from visit 1 to 2011, exposure categories: 0 day, 1 day-2.8 years, 2.8-4.4 years, >4.4 years). The outcome was incident dementia after visit 5. Cox proportional hazard models were used, adjusted for demographics, comorbid conditions, and other medication use. A total of 5,712 dementia-free participants at visit 5 (mean age 75.4 ± 5.1 years; 22% Black race; 58% female) were included in our analysis. The median follow-up was 5.5 years. The minimum cumulative PPI use was 112 days, and the maximum use was 20.3 years. There were 585 cases of incident dementia identified during follow-up. Participants using PPIs at visit 5 were not at a significantly higher risk of developing dementia during subsequent follow-up than those not using PPIs (hazard ratio (HR): 1.1 [95% confidence interval (CI) 0.9-1.3]). Those who used PPIs for >4.4 cumulative years before visit 5 were at 33% higher risk of developing dementia during follow-up (HR: 1.3 [95% CI 1.0-1.8]) than those reporting no use. Associations were not significant for lesser durations of PPI use. Future studies are needed to understand possible pathways between cumulative PPI use and the development of dementia. This study provides Class III evidence that the use of prescribed PPIs for >4.4 years by individuals aged 45 years and older is associated with a higher incidence of newly diagnosed dementia.

Current use of proton pump inhibitors and when to limit, stop or not start treatment

Proton pump inhibitors (PPIs) are potent inhibitors of gastric acid secretion that have changed treatment practice for gastric acid-related disorders. The major adequate indications for their use are treatment of gastro-esophageal reflux disease, peptic ulcers, eradication of Helicobacter pylori infection in combination with antibiotics and prophylaxis for patients on non-steroidal anti-inflammatory or antiplatelet drugs. Since their introduction, clinical success has been accompanied by widespread use of PPIs, which has steadily increased over the last decades without concomitant increase in the incidence of acid-related disorders. PPIs are now among the most widely prescribed class of medications worldwide and around 10% of Icelanders are current PPI users. This increase has been linked to PPI prescription without an indication, or continued use for longer duration than recommended. In recent years, concerns have been raised about PPI overuse and the associated increased risk of harm, not only in terms of increased costs but also the potential risk of physical dependence and long-term side effects of PPIs. The article is based on search in PubMed, the authors' own clinical experience and research, and is intended to provide practice advice on the use of PPIs with focus on appropriate prescription and deprescription of PPIs.

Association between Migraines and Prior Proton Pump Inhibitor Use: A Nested Case-Control Study Using a National Health Screening Cohort.

The effect of proton pump inhibitor (PPI) use on migraine risk remains controversial. We explored the odds of migraines in relation to prior PPI use and treatment duration. Data from the Korean National Health Insurance Service-Health Screening Cohort (2002-2015) were analyzed in this nested case-control study involving 28,159 participants with incident migraines and 112,636 controls (1:4 matched by sex, age, income, and residential region). The baseline covariates were balanced by performing propensity score overlap weighting-based adjustments, and the effect of prior PPI use (past vs. current) and treatment duration (&lt;30 and 30-365 days vs. ≥365 days) on incident migraines was evaluated using logistic regression. In past and current PPI users, prior PPI use raised the likelihood of migraines (adjusted odds ratio [95% confidence interval]: 2.56 [2.36-2.79] and 4.66 [4.29-5.06], respectively). Participants who used PPI for &lt;30, 30-365, or ≥365 days exhibited high odds of migraines (2.49 [2.29-2.72], 4.41 [4.05-4.79], and 4.14 [3.77-4.54], respectively). Incident migraines with or without aura also increased independently of PPI use history or duration. In summary, prior PPI use, irrespective of the elapsed time since use and the duration of use, is possibly associated with incident migraines with or without aura.

Association between Urolithiasis and History Proton Pump Inhibitor Medication: A Nested Case-Control Study.

A few retrospective studies have suggested the risk of urolithiasis associated with the use of proton pump inhibitors (PPIs). The current research intended to estimate the risk of urolithiasis according to previous PPI use. A nested case-control study was conducted using the National Health Insurance Service-National Health Screening Cohort in Korea. A total of 28,962 patients with urolithiasis and 115,848 control participants were selected. The previous prescription history of PPI with days of PPI prescription was collected. To calculate the odds ratios (OR) of past, current, and days of PPI use for urolithiasis, logistic regression models were used. Subgroup analyses were conducted. The urolithiasis group demonstrated a higher rate of current PPI users than the control group (60.9% vs. 43.7%). The current PPI users indicated 2.49 times higher odds for urolithiasis than no PPI users (95% confidence intervals [CI] = 2.33–2.66). A longer duration of PPI use was associated with greater odds for urolithiasis (adjusted OR = 1.65 (95% CI = 1.54–1.77) < 1.97 (95% CI = 1.84–2.11) < 2.32 (95% CI = 2.14–2.49) for 1–19 days, 30–364 days, and 365 or more days of PPI prescription). All subgroup analyses described a consistently positive association of previous PPI use with urolithiasis. Prior PPI use was related to a higher risk of urolithiasis. The relationship between previous PPI use and urolithiasis demonstrated a dose-response association.

Association between Benign Paroxysmal Positional Vertigo and Previous Proton Pump Inhibitor Use: A Nested Case-Control Study Using a National Health Screening Cohort.

The present nested case–control study evaluated the impact of previous proton pump inhibitor (PPI) prescription on the risk of benign paroxysmal positional vertigo (BPPV). A ≥40-year-old Korean population was included. A total of 34,441 patients with BPPV was matched with 137,764 comparison participants for demographic and socioeconomic factors. Previous histories of PPI use and PPI prescription dates were compared between the BPPV and comparison groups. The odds ratios (ORs) with 95% confidence intervals (CIs) of PPI use for BPPV were calculated using a logistic regression. The demographic and socioeconomic factors and comorbidities were adjusted in the adjusted model. Both current and past PPI users were associated with higher odds for BPPV than non-PPI users (adjusted OR (aOR) = 3.57, 95% CI = 3.33–3.83, and p < 0.001 for current PPI users and aOR = 1.76, 95% CI = 1.64–1.89, and p < 0.001 for past PPI users). In addition, longer dates of PPI use were related to higher odds for BPPV (aOR (95% CI) = 1.95 [1.81–2.10] for ≥1 day and <30 days of PPI prescription, <2.88 [2.68–3.10] for ≥30 days and <365 days of PPI prescription, and <3.45 [3.19–3.73] for ≥365 days of PPI prescription). PPI use was linked with an elevated risk of BPPV in the adult population. The odds for BPPV were higher in patients with a longer duration of PPI use.

Associations between proton pump inhibitors and Alzheimer’s disease: a nested case–control study using a Korean nationwide health screening cohort

BackgroundSafety concerns against the use of proton pump inhibitors (PPIs) based on the risk of dementia, especially Alzheimer’s disease (AD), remain controversial. Here, we investigated the likelihood of AD depending on previous PPI exposure, use duration, and PPI generation.MethodsThis nested case–control study comprised 17,225 AD patients who were 1:4 matched with 68,900 controls for age, sex, income, and region of residence from Korean National Health Insurance Service-Health Screening Cohort data between 2002 and 2015 using propensity-score matching method. Conditional and unconditional logistic regression analyses were used to evaluate the effects of previous PPI use on AD adjusting for multiple covariates.ResultsPrior PPI use increased likelihood for AD in current and past PPI users (adjusted odds ratio 1.36 [95% confidence interval (CI) = 1.26–1.46] and 1.11 [95% CI = 1.04–1.18], respectively). Participants with either < 30 days, 30–90 days, or > 90 days of PPI prescription showed higher odds for AD (1.13 [95% CI = 1.07–1.19]; 1.18 [95% CI = 1.10–1.27]; 1.26 [95% CI = 1.16–1.36], respectively). Participants with either 1st-generation or 2nd-generation PPIs demonstrated higher incidences of AD in those with < 30 days (1.14 [95% CI = 1.07–1.22] and 1.13 [95% CI = 1.05–1.22], respectively), 30–90 days (1.19 [95% CI = 1.09–1.30] and 1.17 [95% CI = 1.05–1.29], respectively), or > 90 days (1.18 [95% CI = 1.07–1.30] and 1.27 [95% CI = 1.14–1.43], respectively) of prescription.ConclusionsPrior PPI use, regardless of current or past exposure, duration of use, or use of 1st- or 2nd-generation PPIs, may increase likelihood of AD, providing supportive evidence of previous pharmacoepidemiologic studies.

The association between chronic rhinosinusitis and proton pump inhibitor use: a nested case–control study using a health screening cohort

This study aimed to evaluate the relationship between chronic rhinosinusitis (CRS) and proton pump inhibitor (PPI) use in a Korean population. The Korea National Health Insurance Service-National Sample Cohort was assessed from 2002 to 2013. Patients with CRS (n = 7194) and control participants (n = 28,776) were matched by random order at a 1:4 ratio for age, sex, income group, region of residence, and index date. We analyzed PPI use by patients with and without CRS. ICD-10 codes defined CRS, and claim codes defined previous PPI use. Conditional logistic regression analyzed the crude and adjusted odds ratios (ORs) with 95% confidence intervals (CI). Subgroup analyses were performed according to age and sex. There was a difference in PPI prescription history and prescription duration between the CRS and control groups. The rate of CRS was higher in current (33.8% [263/778]) and past (26.3% [713/2708]) PPI users than PPI non-users (19.1% [6218/32,484], P < 0.001). The adjusted OR (aOR) of CRS with/without nasal polyps was 1.71 (95% CI 1.46–2.02, P < 0.001) and 1.28 (95% CI 1.16–1.41, P < 0.001) in current and past PPI users, respectively. Irrespective of PPI prescription days, PPI use was associated with higher CRS occurrence (aOR 1.46; 95% CI 1.26–1.69, P < 0.001) in the 30–89-day PPI user group. The subgroup analyses results were consistent. The ORs of CRS were higher in PPI users than in the controls, and consistently so in all age and sex groups.

259 Proton pump inhibitor use is not significantly associated with severe COVID-19 related outcomes after extensive covariate adjustment

OBJECTIVES/GOALS: Using the covariate-rich Veteran Health Administration data, estimate the association between Proton Pump Inhibitor (PPI) use and severe COVID-19, rigorously adjusting for confounding using propensity score (PS)-weighting. METHODS/STUDY POPULATION: We assembled a national retrospective cohort of United States veterans who tested positive for SARS-CoV-2, with information on 33 covariates including comorbidity diagnoses, lab values, and medications. Current outpatient PPI use was compared to non-use (two or more fills and pills on hand at admission vs no PPI prescription fill in prior year). The primary composite outcome was mechanical ventilation use or death within 60 days; the secondary composite outcome included ICU admission. PS-weighting mimicked a 1:1 matching cohort, allowing inclusion of all patients while achieving good covariate balance. The weighted cohort was analyzed using logistic regression. RESULTS/ANTICIPATED RESULTS: Our analytic cohort included 97,674 veterans with SARS-CoV-2 testing, of whom 14,958 (15.3%) tested positive (6,262 [41.9%] current PPI-users, 8,696 [58.1%] non-users). After weighting, all covariates were well-balanced with standardized mean differences less than a threshold of 0.1. Prior to PS-weighting (no covariate adjustment), we observed higher odds of the primary (9.3% vs 7.5%; OR 1.27, 95% CI 1.13-1.43) and secondary (25.8% vs 21.4%; OR 1.27, 95% CI 1.18-1.37) outcomes among PPI users vs non-users. After PS-weighting, PPI use vs non-use was not associated with the primary (8.2% vs 8.0%; OR 1.03, 95% CI 0.91-1.16) or secondary (23.4% vs 22.9%;OR 1.03, 95% CI 0.95-1.12) outcomes. DISCUSSION/SIGNIFICANCE: The associations between PPI use and severe COVID-19 outcomes that have been previously reported may be due to limitations in the covariates available for adjustment. With respect to COVID-19, our robust PS-weighted analysis provides patients and providers with further evidence for PPI safety.

Use of Proton-Pump Inhibitor Is Not Associated with Adverse Clinical Outcomes in COVID-19 Patients: A Territory-Wide Cohort Study

Background. Evidence regarding the use of proton-pump inhibitors (PPIs) in COVID-19 patients remains elusive. Aim. To examine the potential effects of PPI use on the clinical outcomes of COVID-19 patients in a territory-wide cohort. Methods. A retrospective cohort study was performed using data from a territory-wide database in Hong Kong. Patients diagnosed with COVID-19 from 23 January 2020 to 1 January 2021 were identified by virological results. The primary endpoint was a composite of intensive care unit admission, use of invasive mechanical ventilation, and/or death. PPI users were identified by PPI use within 12 months prior to their diagnosis of COVID-19. Results. We identified 8,675 COVID-19 patients (mean age 46 years, 49% male, 97.6% of all reported cases in Hong Kong), of which 579 (6.7%) patients had used PPI. PPI users were found to be older, more likely to have comorbidities, concomitant medications and unfavourable laboratory parameters than nonusers. Of the 8,675 COVID-19 patients, 500 (5.8%) developed the primary endpoint. After propensity score (PS) balancing for patients’ demographics, comorbidities, laboratory parameters, and use of medications, PPI use was not found to be associated with the development of primary endpoint in PS weighting (weighted hazard ratio (HR) 1.10, 95% confidence interval (CI) 0.82–1.46, P = 0.529 ), and PS matching analysis (weighted HR 0.79, 95% CI 0.56–1.13, P = 0.198 ). Consistent nonassociation was observed after multivariable adjustment (adjusted HR 0.84, 95% CI 0.67–1.06, P = 0.142 ), and in subgroups of current and past PPI users. Conclusion. PPI use is not found to be associated with adverse clinical outcomes in COVID-19 patients. The result remains robust after PS weighting, PS matching, and multivariable adjustment.

Understanding the Patient PPI Journey: Results of a Survey on PPI Treatment Initiation and Patient Experience.

Introduction:Proton pump inhibitors (PPIs) used in the management of gastro-esophageal reflux disease (GORD) are among the most frequently prescribed classes of drug worldwide. Currently, however, physicians are prescribing PPIs for extended periods, often without an indication, which is not in line with current guidance and therefore preventing appropriate reflux management. Inappropriate or excessive PPI prescribing is becoming increasingly visible, yet there is currently little research available on the impact such current practice has on the patient experience. This study aims to understand patient attitudes toward their PPI treatment and the impact current PPI prescribing patterns have on the patient experience.Methods:An online survey of current and previous users of PPI for GORD was conducted in the UK and Germany. Topics covered included prior steps taken before first consultation with a physician, initial recommendations, PPI treatment initiation and duration, use of PPI, management of reflux whilst taking a PPI, stopping PPI treatment, and patient attitudes.Results:Among 566 patient participants (UK, n = 372; Germany, n = 194) 69% to 79% reported being prescribed medication at their first visit to a physician, of which 61% to 68% were prescribed a PPI either alone or combined with another treatment. 41% to 48% of patients answered “don’t know” when asked how long they expected to continue taking their PPI. 49% to 50% of patients currently on PPIs also reported having concerns with regards to long-term treatment. 70% of patients recalled being well informed on dosage and treatment regimens. However, other safety and usage information was reported as being less frequently discussed.Conclusions:Although patients reported concerns regarding ongoing long-term PPI treatment, this was not reflected in the prescribing pattern from physicians. More can be done to ensure patients are fully informed about their PPI treatment at consultation. Findings also suggest a disconnect exists between standard treatment guidelines and prescribing patterns, as experienced by patients.

Proton-pump inhibitor use and risk of community-acquired pneumonia in congenital heart disease patients

BackgroundAdults with congenital heart disease (CHD) are at elevated risk of hospitalization for community-acquired pneumonia (CAP). Proton-pump inhibitors (PPIs) have been shown to be a risk factor for CAP in adult and pediatric general populations. This study explored the association between PPI use and subsequent CAP hospitalizations in the adult CHD population. MethodsUsing the Danish National Patient Registry, we performed a nested case-control study of adults with CHD who had been admitted to the hospital for CAP between 1996 and 2017. The timing and dose of PPI were evaluated in the year preceding the CAP admission. Logistic regression measured the impact of timing and dose of PPI on the subsequent CAP admission. ResultsIn total, 618 adult CHD patients were admitted for CAP during the study period. The adjusted odds ratio (OR) was 2.21 (95% confidence interval (CI) 1.66–2.94) for CAP in current PPI users compared with non-users. The OR amongst current PPI users was further elevated for males, those older than 65 years old and those with severe/univentricular CHD [3.59 (95% CI 2.33–5.52), 2.30 (95% CI 1.55–3.41), 2.35 (95% CI 1.13–4.87)], respectively. Segmenting by dose, the OR for CAP patients taking low-dose and high-dose PPI was 2.11 (95% CI 1.38–3.22) and 2.29 (95% CI 1.60–3.26), respectively. ConclusionsAdults with CHD prescribed a PPI are at elevated risk of hospitalization for CAP in the following 90 days. The risk for CAP admission is further increased for those prescribed high-dose PPIs, males, those older than 65 years of age, and those with severe/univentricular CHD.

Helicobacter pylori screening in clinical routine during hospitalization for acute myocardial infarction

Potent antithrombotic therapy has significantly improved prognosis for patients with acute myocardial infarction (AMI), however, at a price of increased bleeding risk. Chronic gastric infection with Helicobacter pylori (Hp) commonly causes upper gastrointestinal bleeding and is proposed as a risk factor for subsequent bleeding post AMI. The prevalence of active Hp in a current AMI population and the feasibility of Hp screening as part of routine clinical care are unclear. To determine the prevalence of active Hp infection in a contemporary AMI cohort and to establish the feasibility of Hp diagnosis as part of routine clinical MI care. Multicenter, prospective cohort study. Two university hospitals in Stockholm, Sweden. Patients admitted for AMI between November 6, 2019 and April 4, 2020. After written informed consent, Hp diagnostics was performed with a bedside urea breath test (Diabact, Mayoly Spindler) incorporated into routine care during the hospitalization period. Positive test for Hp infection. The primary outcome was the prevalence of Hp infection. Secondary aims included predictive factors in patient characteristics and outcomes which were obtained from linkage with national registries. Predefined subgroup analyses included stratification for proton pump inhibitor use and infarct type. Three hundred and ten consecutive AMI patients (median age 67; 23% female; 41% ST-elevation MI [STEMI]) were enrolled. Overall, the Hp prevalence was 20% (95%CI, 15.5-24.7). Hp positive status was significantly more common in smokers compared with nonsmokers (36% vs 21%, respectively; P < .05) and in patients presenting with STEMI compared with Non-STEMI (26% vs 15%, respectively; P = .02). The latter observation remained significant after multivariable adjustment. After exclusion of 97 subjects with current proton pump inhibitor use, the Hp prevalence was 24% (95%CI, 18.9-31.0). Active Hp infection is common in a contemporary AMI population and may represent a modifiable risk factor for upper gastrointestinal bleeding, which has been hitherto disregarded. Hp screening as part of clinical routine during AMI hospitalization was feasible. A future randomized trial is needed to determine whether routine Hp screening and subsequent eradication therapy reduces bleeding complications and improves prognosis. Question: Is Helicobacter pylori (Hp) infection sufficiently common in patients with acute myocardial infarction (AMI) to consider systematic screening, and can Hp diagnostics be performed during AMI hospitalization? In this multicenter prospective cohort study of 310 consecutive AMI patients, Hp infection was established in at least 20% of patients. Infected patients were significantly more likely to be active smokers and to present with ST-elevation MI. Meaning: Hp screening as part of clinical routine during AMI hospitalization was feasible. Given the high Hp prevalence detected, Hp diagnostics and eradication to reduce bleeding complications and to improve prognosis after AMI should be further investigated.

S3140 Does Age Influence How Gastroenterology Patients View Adverse Effects of Proton Pump Inhibitors?

INTRODUCTION: Proton Pump Inhibitors (PPIs) are generally considered to be safe. Recently, observational studies have associated PPI use with new adverse drug reactions (ADRs) including chronic kidney disease, dementia, and hypomagnesemia. Few studies have addressed patient awareness of potential PPI-related ADRs and its effect on continued use of PPIs. In 2019, our group reported that most gastroenterology patients on PPIs were unaware of ADRs, but when alerted to potential ADRs, 60% expressed some degree of concern. We now report new findings on the influence of age on knowledge and concern about PPI-related ARDs and likelihood of discontinuing PPIs. METHODS: An anonymous survey with 15 multiple choice questions regarding PPI use was distributed to adults from our community outpatient endoscopy center at Advocate Lutheran General Hospital from June 2019 to January 2020. The survey included demographic information, indication and duration of PPI use, awareness of PPI ADRs, level of concern for ADRs, and drug discontinuation. RESULTS: 537 patients (14%) indicated current PPI use and are the subject of this analysis. 52 individuals were between the ages of 18-39 years (Group A = A), 276 were between the age of 40-65 years (Group B= B), and 209 individuals were > age 65 (Group C= C). The most common patient identified ADRs related to PPI use in all age groups were osteoporosis and Vitamin B12 deficiency (Figure 1). Most patients (55%) reported that they were unaware of any ADRs from PPIs. For patients aware of ADRs, the most common source of this information was from healthcare providers (A n = 10, B n = 60, C n = 42), and the Internet (A n = 9, B n = 41, C n = 16) (Figure 2). 377 patients (70%) expressed concern regarding ADRs. 21% expressed extreme concern (A n = 5, B n = 18, C n = 19), 23% moderate concern (A = 4, B = 24, C = 15), 41% were somewhat concerned (A n = 9, B n = 47, C n = 32), and 15% were hardly concerned (A n = 5, B n = 15, C n = 11). Patients over the age of 39 comprised 93% of patients (B n = 28, C n = 10) who discontinued PPIs due to concern about ADRs, compared to only 4 patients in A. CONCLUSION: The majority of patients on PPIs surveyed are unaware of PPI-related ADRs. Older patient populations are more likely to express concern for PPI-related ADRs and more likely to discontinue PPIs as a result.Figure 1.: The graph depicts the most common patient identified potential ADRs by age group.Figure 2.: The graph demonstrates where patients received their information regarding PPI ADRs by age group. Most patients surveyed regardless of age had learned of PPI ADRs from a physician.Figure 3.: The graph depicts the overall concern of patients by age related to PPI ADRs. The majority from all age groups are all somewhat concerned regarding PPI related ADRs.

S3149 Does Gender Play a Role in How Gastroenterology Patients View Adverse Effects of Proton Pump Inhibitors?

INTRODUCTION: Proton Pump Inhibitors (PPIs) are generally considered to be safe. Recent observational studies have associated PPI use with potential adverse drug reactions (ADRs) including chronic kidney disease, dementia, and vitamin deficiencies. Patient awareness of potential ADRs and its effect on continued use of PPIs have received little attention in the medical literature. Our group previously reported initial data showing that the majority of gastroenterology patients taking PPIs are unaware of associated ADRs, but when alerted to ADRs, 60% expressed some degree of concern. We now report new findings on the effect of gender on knowledge and concern about PPI-related ADRs, and likelihood of discontinuing PPIs. METHODS: An anonymous survey with 15 multiple choice questions regarding PPI use (2 questions allowing more than 1 answer) was distributed to adults from our single community outpatient endoscopy center at Advocate Lutheran General Hospital from June 2019 to January 2020. It included demographic information, indication and duration of PPI use, awareness of PPI ADRs, level of concern for ADRs, and drug discontinuation. RESULTS: 3775 surveys were returned, of which 537 patients (14%) [male (M) n = 248 (46%), female (F) n = 289 (54%)], were current PPI users and are the subject of this analysis. The most common indications for PPI usage were heartburn (M n = 137, F n = 161) and GERD (M n = 124, F n = 149). Females were more aware of individual PPI-associated ARDs than males (Figure 1). The most common patient-identified ADRs related to PPI use by women was osteoporosis (F n = 53, M n = 18) and in men was vitamin B12 deficiency (M n = 25, F n = 37)Figure 1.: The graph depicts the most common patient identified potential ADRs by gender group. The most frequently identified potential ADRs by women are osteoporosis, low calcium absorption, and B12 deficiency. The most frequently identified potential ADRs by men are Vitamin B12 deficiency, kidney disease, and low iron absorption.Figure 2.: The graph depicts the overall concern of patients by gender related to PPI ADRs. Although women were more concerned than men, the majority are all somewhat concerned regarding PPI related ADRs.Figure 3.: The graph depicts the reason patients, by gender, discontinued their PPI. More women discontinued their PPI due to concern regarding ADRs rather than men.. Of 377 patients (70%) who expressed concern regarding ADRs, 21% expressed extreme concern (F = 58%), 23% moderate concern (F = 69%), 41% were somewhat concerned (F = 51%), and 15% were hardly concerned (F = 61%) (Figure 2). Of 168 patients (32%, M n = 66, F n = 102) who attempted to stop their PPI, 41 patients (24%, M n = 15, F n = 26) reported stopping secondary to ADRs concern (Figure 3). CONCLUSION: The majority of GI patients consuming PPIs are unaware of PPI-related ADRs. Our study data suggests that females are more aware of ADRs and are attentive a variety of ADRs. Females express a greater degree of concern regarding PPI use, and are more likely to discontinue their PPI therapy compared to males.