Antisecretory drugs increase the risk of developing C. diarrhea associated with difficult by 3 times
According to the results of a retrospective study, the continuous use of proton pump inhibitors more than 3 times increases the risk of developing diarrhea associated with Clostridium difficile.
A significant number of retrospective studies have been conducted in Western Europe, in which a direct relationship has been found between prolonged use of proton pump inhibitors (PPIs) and the development of diarrhea associated with Clostridium difficile.
The study in Japan aimed to determine if there is a similar trend in Japan on the example of one of the medical institutions.
The study included patients admitted to the Department of Internal Medicine at the university clinic from April to June 2010, and in addition, until April 2011, researchers continued to determine the toxin C. difficile in the chair. The criterion for long-term treatment of PPI was taking medication for 30 days or more. The diagnosis of diarrhea associated with Clostridium difficile was made on the basis of the clinical picture of the disease (presence of diarrhea) and the results of a microbiological examination (detection of toxins Clostridium difficilein the stool).
During the PPI study, 487 (59.8%) of the 816 patients were prescribed. People who took STIs were older than those who didn't (68.9 years vs 63.1 years; p less than 0.01), moreover, men predominated among them (2.26 vs 1.36; p less than 0.01).
Long-term use of PPIs has been associated with a 3.2-fold increase in the risk of developing diarrhea associated with Clostridium difficile. Among 487 patients on PPI, 19 cases of diarrhea associated with Clostridium difficile were recorded, among 329 patients who did not receive PPI, 4 cases (relative risk 3.20; confidence interval 95%, 1.10 - 9.32; p = 0.02).
The appointment of PPIs should be treated with more caution and applied according to strict guidelines. In addition, the possibility of a similar effect of H2 blockers on the increased risk of developing diarrhea associated with Clostridium difficile is not excluded. Therefore, if it is necessary to stop a hyperacid state, especially in patients of an older age group, it is recommended to use antacids containing magnesium.
Researchers emphasize the need to limit the use of PPIs. A large number of patients receive these drugs not as directed. It should also be mentioned that calcium absorption is limited due to the hypoacid state created by PPI. And this, in turn, increases the likelihood of developing bone fractures.
In one of the published studies, the dose-dependent effect of proton pump inhibitors was demonstrated, as well as the greater likelihood of developing diarrhea associated with Clostridium difficile due to the use of more potent acid inhibitor drugs. Based on the information received, we can make a hypothesis about the possible pathogenesis of this pathological process - a decrease in the secretion of hydrochloric acid. Clostridium difficile spores are known to be relatively stable in an acidic environment. At the same time, other studies suggest a possible antibacterial effect of PPIs, contributing to the selective effect on the microflora of the large intestine. Therefore, this problem requires further study.