Diagnosis Of GERD Research Articles

Wireless 24, 48, and 96Hour or Impedance or Oropharyngeal Prolonged pH Monitoring: Which Test, When, and Why for GERD?

pH monitoring technologies are routinely utilized in practice to further evaluate symptoms of gastro-esophageal reflux disease and laryngopharyngeal reflux (LPR). This is a review of the recent literature of the available pH monitoring technology and creates an algorithm in the diagnostic work up of a patient with GERD or LPR. The catheter-free wireless pH monitor traditionally collects data for 48h. Recent studies have found that extending to 96h can be helpful in patients with conflicting results on the first 2days of the study. In addition, 96h can allow for testing both on and off of PPI therapy. The oropharyngeal monitoring device is a newer technology that is designed to aid in the diagnoses of LPR. There are limitations with this technology as there is no universal abnormal cutoff and some studies have suggested a poor correlation between multichannel intraluminal impedance-pH (MII-pH) and the oropharyngeal monitoring device. MII-pH has recently developed two additional parameters, the measurement of three 10-min nighttime periods and the post-reflux swallow-induced peristaltic wave (PSPW) index, both of which may increase accuracy of testing. Each of these technologies can provide unique data regarding acid reflux exposure in the esophagus and oropharynx. The wireless pH monitor performed off of PPI therapy can help to establish or exclude the diagnosis of GERD. For those patients with refractory symptoms on PPI, MII-pH study can be performed while on therapy and provides data regarding the response to treatment. Oropharyngeal pH monitoring is being utilized in some practices to aid in diagnosis of LPR, but the scientific validity is controversial.

PS01.018: PERSISTENT DYSPHAGIA AFTER FUNDOPLICATION WITH MESH PLASTY –MISSED OR MISTAKEN –A CASE REPORT

Abstract Background Scleroderma esophagus is a rare entity. Only few case reports of esophagectomy were done and reported for this condition. We are presenting this rare case of failed fundoplication and mesh repair with a diagnosis of GERD and hiatus hernia, which was found later on due to Scleroderma with Esophageal involvement. Methods 58 year old female admitted with dysphagia following laproscopic fundoplication with mesh repair of crura with a diagnosis of GERD and hiatus hernia.She presented with persistent vomiting and loss of weight.On evaluation, her Upper GI scopy revealed dilated esophagus with sluggish peristalisis. Since the patient had tightness of skin over the distal extremities, face and fish mouth appearance with thinning of nail, Skin biopsy was taken. The skin biopsy was reported to be scleroderma.The esophageal manometry demonstrated failed esophageal peristalisis with high normal LES pressure due to tight fundal wrap.The patient was treated with mesh remova, Transhiatal esophagectomy with gastric pull-up and cervical Anastomosis.Post operatively the patient was treated with hydrocholoroquine and predinisolone. Results The patient is free of dysphagia and is on regular follow up. Conclusion In case of failure, detailed evaluation including High resolution manometry (MII HRM) has to be done before doing laparoscopic fundoplication for GERD has to rule out uncommon and rare disorders of esophagus. Detailed clinical examination in GERD patients has to be done to rule out systemic disease like scleroderma.In case of failed fundoplication for GERD, patients have to investigated for the failure.So patients with incapacitating esophageal neuromotor disease, a more radical approach in the form of esophagectomy may be safer and more reliable than attempting another procedure and risk another failure. Disclosure All authors have declared no conflicts of interest.

Su1087 - The “Grey Zone” in Diagnosis of Gastroesophageal Reflux Disease. Does Calculation of Mean Nocturnal Baseline Impedance (MNBI) Help to Obtain a Conclusive Diagnosis of Gerd?

Su1087 - The “Grey Zone” in Diagnosis of Gastroesophageal Reflux Disease. Does Calculation of Mean Nocturnal Baseline Impedance (MNBI) Help to Obtain a Conclusive Diagnosis of Gerd?

Iranian lifestyle factors affecting reflux disease among healthy people in Qom.

Background and aimGastroesophageal reflux disease (GERD) is one of the most common digestive system disorders. Life style factors may increase the risk of reflux disease. We aimed to determine prevalence of reflux and related life style-factors in the population living in Qom.MethodsThis cross-sectional study was conducted among 1500 residents of Qom in 2014. Individuals were selected through multi-stage sampling. They completed two questionnaires: FSSG questionnaire for diagnosis of GERD and a general questionnaire to measure demographic and lifestyle factors. Univariate and multivariate were used for analysis of data. Data were analyzed using IBM SPSS version 20.ResultsA total of 1130 individuals were analyzed in which 52.4% of them were female. Prevalence of GERD was 28%. Adjusted findings showed use of PPIs (OR: 2.2, 95% CI: 2–5), taking H2RAs (OR: 4.7, 95% CI: 2.3–9.4), the habit of quick eating (OR: 1.5, 95% CI: 1.1–2), extra salt consumption on daily meals (OR: 1.5, 95% CI: 1.05–2), lack of sleep (OR: 2.6, 95% CI: 1.5–4.8), and consumption of white bread (OR: 1.7, 95% CI: 1.05–2.7) were related to increased risk of GERD.ConclusionOur findings showed lifestyle factors such as habit of quick eating, extra salt on regular meals, lack of sleep and use of white bread were associate with increased risk of GERD. However, habit of midnight snack, having dinner just before bedtime, lack of breakfast, smoking, drinking tea and coffee were not associated with increased risk of GERD. It is recommended to carry out a cohort study among the Iranian population to evaluate the effect of life-style risk factors on GERD.

Advances in the physiological assessment and diagnosis of GERD.

This corrects the article DOI: 10.1038/nrgastro.2017.130.

Utility of Prolonged 96-hour Wireless pH Monitoring on Diagnosis of GERD and Assessment of Response to PPI Therapy

Utility of Prolonged 96-hour Wireless pH Monitoring on Diagnosis of GERD and Assessment of Response to PPI Therapy

Is histologic esophagitis associated with dental erosion: a cross-sectional observational study?

BackgroundGastroesophageal reflux disease (GERD) affects 15–25% of children and adolescents in the United States. The diagnosis of GERD in children is complex as reported symptoms or symptom profiles have been found to be unreliable. Frequently, the diagnosis must be confirmed by objective tests such as pH monitoring or histological evidence of esophagitis on an esophageal biopsy. Dental erosion has been shown to be associated with GERD as an atypical complication and has the potential to be a marker of GERD. The purposes of this study were to compare the frequency and patterns of dental erosion in children and adolescents with and without histologic esophagitis.MethodsTwenty-five subjects were recruited from patients scheduled for an upper gastrointestinal endoscopy. Information regarding potential GERD symptoms, food habits, and dental hygiene habits were obtained. Intra-oral photographs were taken, and a dental exam for erosion was performed. The results of a standard biopsy taken from the lower third of the esophagus during an endoscopy were used to divide subjects into either the control group or the GERD group (i.e. those with histologic esophagitis).ResultsTwenty-two subjects yielded 586 evaluable teeth. No significant difference was found between frequency or erosion patterns of those with and without histologic esophagitis. Dental erosions were more frequent in primary teeth.ConclusionsDental erosions do not appear to be associated with histologic esophagitis indicative of GERD.

Histopathological Findings Associated With Gastroesophageal Reflux Disease and Aspiration After Lung Transplantation: Initial Brazilian Single-Center Experience

BackgroundGastro-esophageal reflux disease (GERD) and broncho-aspiration (BA) are known to increase the risk for chronic lung allograft dysfunction (CLAD). However, specific lung injury mechanisms are not clearly known. The objective of the study was to describe histopathological findings in surveillance lung transbronchial biopsies that can be correlated with episodes of BA in the lung allograft. MethodsThis retrospective analysis of surveillance transbronchial biopsies was performed in lung transplant recipients, with available data of broncho-alveolar fluid (cultures and cytology), lung function parameters, and esophageal functional tests. ResultsWere analyzed 11 patients, divided into 3 groups: (1) GERD group: 4 patients with GERD and CLAD diagnosis; (2) control group: 2 patients without GERD or CLAD; and (3) BA group: 5 patients with foreign material in lung biopsies. A histopathological pattern of neutrophilic bronchitis (NB) was present in 4 of 4 cases in the GERD group and in 1 of 5 cases in the BA group in 2 or more biopsy samples; culture samples were all negative; the 5 NB-positive patients developed CLAD and died (3/5) or needed re-transplantation (2/5). The other 3 patients in the BA group had GERD without NB or CLAD. Both patients in the control group had transient NB in biopsies with positive cultures but remained free of CLAD. ConclusionsSurveillance transbronchial biopsies may provide useful information other than the evaluation of acute cellular rejection and can help to identify high-risk patients for allograft dysfunction related to gastro-esophageal reflux.

GERD is associated with the outcome of MDD treatment

IntroductionGastroesophageal reflux disease (GERD) is more prevalent among patients with major depressive disorder (MDD) than in general population, and vice versa. Bidirectional association of GERD and MDD is well documented. Although protective effect for gastric symptoms has been indicated for several antidepressants like trazodone, citalopram, fluoxetine, mirtazapine or fluvoxamine, these findings are sometimes contradictory. Similar may be claimed for antidepressive effect of some proton pump inhibitors. We decided to examine the association of GERD with the long-term efficacy of MDD treatment.ObjectiveTo examine the association of GERD and efficacy of MDD treatment.MethodsThis nested cross-sectional study was done during 2016 at Psychiatric hospital Sveti Ivan, Zagreb, Croatia on the sample of 1008 psychiatric patients. Key outcome was the number of psychiatric rehospitalizations since the first diagnosis of MDD. Predictor was patient-self-declared diagnosis of GERD. Covariates controlled by multivariate analysis of covariance were sex, age, duration of MDD in years, education, marital status, number of household members, work status, clinical global impression scale–severity of MDD at diagnosis, treatment with tricyclic antidepressants (TCA), selective serotonin reuptake inhbitors (SSRI), serotonin-norephinephrine reuptake inhibitors (SNRI), noradrenergic and specific serotonergic (NaSSA) and antipsychotics.ResultsMDD patients with GERD had significantly larger number of psychiatric rehospitalizations (mean = 5.4 (SD 6.82)) than MDD patients with no GERD (mean = 3.1 (SD 4.45)). After adjustment for all covariates, GERD significantly moderated the efficacy of treatment of MDD (P = 0.048; η2 = 0.05) (Figure 1).ConclusionTo treat MDD effectively we should treat GERD as well.Disclosure of interestThe authors have not supplied their declaration of competing interest.

157 - Novel Balloon Mucosal Impedance for Diagnosis of Gerd and EOE

157 - Novel Balloon Mucosal Impedance for Diagnosis of Gerd and EOE

Knowledge of pediatrician on gastroesophageal reflux/gastroesophageal reflux disease in children: a preliminary study

Background Gastroesophageal reflux (OER) is involuntary movement of gastric content into esophagus due to transient lower esophageal sphincter relaxation. This condition usually ignored by physician. Many GER cases have severe complication before properly managed. Ten years after incorporating GER into Indonesia pediatric training curriculum, the knowledge of GER among pediatrician need to be measured.Objectives To measure pediatrician's knowledge of GER/GERD in children.Methods This was a cross sectional study using questionnaire and interview.Result There were 387 respondents who filled the questionnaire and being interviewed. The majority of respondents were between 25-45 years old (33.6%). Respondents who graduated before the year 2000 were 48.3%, and after 2000 were 51.7%. Majority of respondents were general pediatrician (90.2%) and 41.3% working in teaching hospitals Among pediatricians graduated after year 2000,6 6%,5 0.5% and 57.5% could gave more than 80% correct answer to questions about general knowledge, diagnosis and management of GERD as compared to 49.2%, 42.2% and 47% subjects graduated before year 2000. More pediatricians graduated before year 2000 answered the questions on general knowledge, diagnosis and management < 60% correctly compared to those graduated after year 2000 (42.2%, 25.2% and 28.3% vs. 14%,11.5% and 12%, respectively). Fifty five of 160 (34.4%) respondents who working in teaching hospital gave more than 80% correct answer to questions about GERD. Compared to those working in non-teaching hospitals, only 17.6% were able to correctly answer more than 80% of questions.Conclusions Better knowledge about GER/GERD are found among pediatricians graduated after the topics has been introduced to the curriculum and among those practicing in teaching hospitals.

Efficiency of preoperative esophagogastroduodenoscopy in identifying operable hiatal hernia for bariatric surgery patients

BackgroundGastroesophageal reflux (GERD) is a symptom frequently found in obese patients, and often is related to the presence of a hiatal hernia (HH). Surgeons may evaluate for the presence of HH on esophagogastroduodenoscopy (EGD). However, preoperative endoscopic presence or absence of a significant HH does not always correlate with intraoperative findings. ObjectiveTo compare the rate of detection of repairable HH between clinical, endoscopic, and intraoperative methods SettingIndependent, university-affiliated teaching hospital MethodsA retrospective chart review of all consecutive patients who had undergone a primary bariatric procedure sleeve gastrectomy, gastric bypass, or biliopancreatic diversion/duodenal switch with routine preoperative EGD in a single institution from 2009–2013 was performed. Data points included the diagnosis of GERD/heartburn/proton pump inhibitor or histamine antagonist from history, the diagnosis of HH from preoperative EGD, and the diagnosis of HH intraoperatively that merited repair. Results1570 consecutive patients were included in the study. Eight hundred fifty-seven (55%) had diagnosis of GERD or heartburn, and 713 (45%) were asymptomatic (negative for GERD or heartburn). Hiatal hernia repair was performed in 153 (18%) patients with the diagnosis of GERD or heartburn and in 107 (15%) patients without the diagnosis of GERD and or heartburn. In all, 434 (28%) out of 1570 patients had a finding of HH on EGD; 204 (47%) were repaired. On endoscopy, 326 (75%) were defined as small, 87 (20%) as moderate, and 21(5%) as large HH. Of these, repairs were done on 128 (39%), 60 (70%), and 16 (76%). The sensitivity of detecting repairable HH by clinical indicators such as GERD or heartburn was 55% (P = .123) and sensitivity of EGD findings was 78% (P = .000). Specificity was 46% and 82%, respectively. ConclusionSmall HH are over-diagnosed with EGD, as most do not require repair. However, moderate and large HH are accurately detected.

Management of refractory typical GERD symptoms

The management of patients with refractory GERD (rGERD) is a major clinical challenge for gastroenterologists. In up to 30% of patients with typical GERD symptoms (heartburn and/or regurgitation), acid-suppressive therapy does not provide clinical benefit. In this Review, we discuss the current management algorithm for GERD and the features and management of patients who do not respond to treatment (such as those individuals with an incorrect diagnosis of GERD, inadequate PPI intake, persisting acid reflux and persisting weakly acidic reflux). Symptom response to existing surgical techniques, novel antireflux procedures, and the value of add-on medical therapies (including prokinetics and reflux inhibitors) for rGERD symptoms are discussed. Pharmaceutical agents targeting oesophageal sensitivity, a condition that can contribute to symptom generation in rGERD, are also discussed. Finally, on the basis of available published data and our expert opinion, we present an outline of a current, usable algorithm for management of patients with rGERD that considers the timing and diagnostic use of pH-impedance monitoring on or off PPI, additional diagnostic tests, the clinical use of baclofen and the use of add-on neuromodulators (tricyclic agents and selective serotonin reuptake inhibitors).

Is the Routine Use of Impedance Analysis for the Diagnosis of Gastro-Esophageal Reflux Disease More Expensive than Conventional pH Monitoring? Cost Analysis of Two Procedures.

Conventional 24-h pH monitoring is the gold standard for the diagnosis of non-erosive, non-acidic gastro-esophageal reflux disease. Multichannel Intraluminal Impedance (MII) analysis markedly improves diagnostic accuracy of non-erosive, non-acidic gastro-esophageal reflux disease. However, MII catheters are more expensive than standard catheters. This study aimed to determine the rates of acid or non-acid reflux and by making a retrospective projection, to predict the costs of two algorithms. We retrospectively reviewed the medical data of 102 patients who presented to our hospital with suspected non-erosive GERD and underwent 24h impedance/pH-monitoring. Demographic characteristics, Demeester scores, number of reflux episodes, and results of impedance analysis were recorded. According to these data, cost was calculated either for the scenario in which impedance measurement was performed solely or following a negative conventional pH monitoring. Thirty-seven of all 102 patients (36.3%) had a Demeester score greater than 14.7. These patients were assigned as group 1 (acid reflux). The impedance analysis of the remaining 65 patients detected 34 patients (33.3%) to have more than 50 reflux episodes over a period of 24h and assigned as Group 2, and 31 patients (30.4%) had no reflux (group 3). The cost of the single- step algorithm using MII catheter was calculated as $15,300, while the total cost of two-step scenario would have been predicted as $16,890. Our study showed that an initial conventional pH monitoring can make the diagnosis of GERD in only one third of the patients with suspected non-erosive GERD. In nearly two-thirds of patients, however, repeated procedures and use of impedance catheters are needed. It is clear that this algorithm has certain drawbacks with regard to cost, patient comfort, and workforce loss.

Enfermedad por reflujo gastroesofágico

IntroductionGastro-oesophageal reflux disease (GERD) arises as complication of sustained nonphysiological reflux, with a balance between protective and aggressive factors that favours the latter. AetiopathogenesisThe main mechanism consists of transient relaxations of the lower oesophageal sphincter (LES), although a hiatal hernia or an LES with sustained hypotension can contribute. Clinical manifestationsThis imbalance leads to a series of manifestations including heartburn and the sensation of reflux, although many other symptoms can occur such as dysphagia, sore throat and even extraoesophageal manifestations. DiagnosisThe diagnosis of GERD can be established by clinical improvement after several weeks of medical treatment. However, in certain scenarios, endoscopy or other additional tests might be necessary to rule out various processes. TreatmentThe medical treatment of GERD is based on the use of proton pump inhibitors (PPI), although surgery might be required in certain cases.

An evaluation of olfactory function in adults with gastro-esophageal reflux disease

Conclusion: To the best of the authors’ knowledge, this study is the first to evaluate the olfactory function of adult patients diagnosed with GERD. The results revealed that adults with GERD have diminished olfactory function. Objective: This study aimed to evaluate the olfactory abilities of subjects using the ‘Sniffin’ Sticks’ olfactory test. Methods: A total of 35 men and women aged 18–60 years with a diagnosis of GERD and 45 healthy controls were included in the study. The Sniffin’ Sticks olfactory test results of the two groups were compared, and the relationship between the study findings and the olfactory parameters was evaluated. Results: The odor threshold (10.1; 9.5, p = 0.016), odor identification (9.6; 8.1, p < 0.001), and odor discrimination (10.7; 8.9, p < 0.001) of the GERD group were significantly lower than those of the control group. A statistically significant positive correlation was detected between the accompanying chronic pharyngitis, chronic sinusitis, and odor parameters. A significant correlation was not detected between the laryngeal findings and the olfactory parameters.

Misdiagnosis of gastroesophageal reflux disease as epileptic seizures in children

BackgroundGastroesophageal reflux disease (GERD) can mimic epileptic seizure, and may be misdiagnosed as epilepsy. On the other hand, GERD can be more commonly seen in children with neurological disorders such as cerebral palsy (CP); this co-incidence may complicate the management of patients by mimicking refractory seizures. ObjectiveThe purpose of our study was to evaluate the clinical features, definite diagnoses and treatment approaches of the patients with clinically suspected GERD who were referred to the division of pediatric neurology with a suspected diagnosis of epileptic seizure. We also aimed to investigate the occurrence of GERD in children with epilepsy and/or CP. MethodsFifty-seven children who had a final diagnosis of GERD but were initially suspected of having epileptic seizures were assessed prospectively. ResultsAll patients were assigned to 3 groups according to definite diagnoses as follows: patients with only GERD who were misdiagnosed as having epileptic seizure (group 1: n=16; 28.1%), those with comorbidity of epilepsy and GERD (group 2: n=21; 36.8%), and those with the coexistence of GERD with epilepsy and CP (group 3: n=20; 35.1%). Five patients (8.8%) did not respond to anti-reflux treatment and laparoscopic reflux surgery was performed. The positive effect of GERD therapy on paroxysmal nonepileptic events was observed in 51/57 (89.5%) patients. ConclusionsGERD is one of the important causes of paroxysmal nonepileptic events. In addition, GERD must be kept in mind at the initial diagnosis and also in the long-term management of patients with neurological disorders such as epilepsy and CP.

Gastroesophageal reflux disease and odds of head and neck squamous cell carcinoma in North Carolina.

Exposure to excess gastric acid resulting from gastroesophageal reflux disease, also known as acid reflux or heartburn, might contribute to initiation of head and neck squamous cell carcinoma, particularly laryngeal cancer. Prior epidemiologic studies have reported inconsistent results. We sought to clarify this relationship using an observational study with a larger available sample size and better-characterized exposure information than most prior studies. A population-based case-control study of head and neck cancer in North Carolina with 1,340 newly diagnosed cases and 1,378 controls matched on age, race, and sex. We used unconditional logistic regression to examine associations between self-reported heartburn and development of overall head and neck cancer as well as development of cancer at specific tumor sites. Subgroup analysis by smoking and alcoholic drinking status was used to make comparisons with a previous study that used a similar study design. Overall, an increased odds of head and neck cancer was not associated with either self-reported history of heartburn symptoms (odds ratio = 0.85; 95% confidence interval 0.68, 1.06) or self-reported medical diagnosis of GERD (OR = 0.89; 95% CI 0.71, 1.11). These patterns held for specific tumor sites. For laryngopharyngeal cancer, we did not detect any associations regardless of joint smoking and alcoholic drinking status. Gastroesophageal reflux does not appear to play a role in development of head and neck cancer. 3b. Laryngoscope, 126:1091-1096, 2016.

Role of Ambulatory Distal Esophageal pH Monitoring in Patients With Laryngopharyngeal Reflux (LPR) and Gastroesophageal Reflux Disease (GERD)

Introduction: LPR is primarily a clinical diagnosis based on symptoms such as cough, globus, hoarseness and throat clearing thought to be due to reflux of gastric contents into larynx. Some of these patients do not have typical symptoms of heartburn and acid regurgitation which can make the diagnosis challenging. Though not 100% sensitive, the gold standard test for detection of reflux is distal esophageal pH monitoring with 24-hour pH or 48-hour pH testing. Therefore, our aim was to assess the role of distal esophageal pH testing in patients with LPR. Methods: The study group (Group A) consisted of the patients with a diagnosis of LPR who underwent either 24 pH test with a single probe transnasal catheter positioned 5 cm above gastroesophageal junction (GEJ) or 48 hour wireless bravo probe placed endoscopically 6 cm above the GEJ in our GI lab from 2006 to 2014. Group B consisted patients with the diagnosis of GERD only (heartburn or acid regurgitation more than two days a week) and group C comprised of patients with a diagnosis of GERD and LPR. In addition to pH testing, all groups had high resolution esophageal manometry (HREM) and otolaryngeal (ENT) evaluation. Variables such as age, gender, BMI and pH parameters including total acid exposure, supine and upright acid exposure, Symptom index (SI), Symptom sensitivity index (SSI) and symptom association probability (SAP) were noted. Results: A total of 239 patients underwent pH testing during the study period. There were 67 patients in Group A (LPR only), 107 patients in Group B (GERD only) and 68 patients in group C (GERD+ LPR). Only 43.3% in Group A, 50.5% in group B and 55.4% in group C had abnormal pH testing (Table 1). There were no significant differences in the three groups in terms of total, supine and upright acid exposure. SI, SSI and SAP were lower in group A than in group B and group C (although not statistically significant).Table 1: Esophageal pH Testing in LPR and GERDConclusion: Esophageal pH testing is normal in approximately half the patients with a clinical diagnosis of LPR, GERD or a combination. Hence, a diagnosis of LPR cannot be reliably made on the results of distal esophageal pH monitoring alone.

Factors Influencing Risk for Developing Pneumonia Amongst Proton Pump Inhibitor (PPI) Users

Introduction: Proton Pump inhibitors (PPIs) are widely used medication for variety of indications and generally well tolerated. Several studies have revealed the increased risk of pneumonia in patients taking PPIs. The goal of our study is to evaluate risk factors in PPI users, which can contribute to the acquisition of pneumonia. Methods: Our case-control study included 408 patients who were admitted to SUNY Upstate University hospital between Jan 2011 and Dec 2012. The cases had a primary diagnosis of community acquired pneumonia (CAP) or healthcare associated pneumonia (HCAP) with chest x-ray evidence of pneumonia and the controls had a primary diagnosis of chest pain without clinical or radiological evidence of pneumonia. The cases and the controls included subgroups of patients who used PPI vs. those who did not. Patients aged 18 years and above were enrolled. Data collection was performed using electronic medical records. Statistical analysis was performed using MS Excel and SPSS V.17 including descriptive statistics. Results: A total of 408 patients (cases 166 and 242 controls) were enrolled in the study. Out of all patients on PPI, 45% patients were started on PPI for stress ulcer prophylaxis. There was no difference between M: F ratio or average age between 2 groups. We found that PPI users have higher risk of acquiring pneumonia (OD - 1.5, P - 0.03). Smokers have higher risk of pneumonia while on PPI as oppose to those not on PPI (OR - 2.62, P - 0.009). Patients with GERD have higher risk of pneumonia while on PPI (OR - 1.80, P - 0.03). Patients with cancer who are on chemotherapy have higher risk of pneumonia while on PPI as compared to those who are not on PPI (OR - 4.2, OR - 0.0001). Use of statin reduces risk of pneumonia among PPI users (OR - 0.46, P - 0.01). History of Diabetes, heart failure, stroke, cirrhosis, Use of ACE inhibitors or systemic steroids did not influence risk of acquiring pneumonia while on PPI. Conclusion: We conclude that use of PPI does increase the risk of acquiring pneumonia. The factors leading to this enhanced risk are smoking, diagnosis of GERD, cancer patients on chemotherapy. Use of statin decreases risk of pneumonia. Re-evaluating need for chronic PPI especially in high risk group patients can help to avoid overuse and possibly decreasing risk of pneumonia in this patient population.