Risk of Pneumonia and Use of Gastric Acid-Suppressive Drugs

About the Study

This study examined 364,863 patients who were known to have used acid-suppressive drugs for at least one year. These patients were identified through a general hospital database of medical records. All of the patients were required to have at least one year of data. The rates of pneumonia development were determined for these patients and compared to the rates of pneumonia development for patients not taking these agents.

To avoid any bias, the authors conducted an additional sub-study that matched patients taking gastric acid-suppressing drugs who had developed pneumonia with patients who had not developed pneumonia.

The Findings

Of the patients identified through the database, 5,551 developed pneumonia during the follow-up period. Current use of acid-suppressing drugs was associated with a small increase in the risk of pneumonia.

The study also evaluated the two classes of drugs separately and found that while both resulted in an increased risk, the increase was more pronounced for patients taking PPIs. The relative risk for each class translates to approximately one case of pneumonia per 226 patients treated with PPIs and one case per 508 patients treated with H2-receptor antagonists.

Additionally, a dose-response relationship was seen with PPIs, meaning that as use of PPIs increased, so did the risk of pneumonia

How Does This Affect You?

The number of patients that present to their doctor with gastrointestinal symptoms is increasing each year. And the indications for gastric-acid suppressing drugs are becoming broader. Some PPIs are now recommended to treat disorders other than GERD, such as stomach problems induced by anti-inflammatory medications like aspirin and ibuprofen. These factors coupled with the aging population means that more and more of these medications are being prescribed. The idea that these agents may pose a risk is not a new one, but studies previous to this trial have only suggested a link between the development of pneumonia and gastric-suppressive agents. The conclusions of this trial should not go unnoticed. While the risk demonstrated is small, pneumonia is a serious and potentially life-threatening condition, particularly in the elderly.

The current standard of care results in many patients being prescribed gastric-acid suppressive agents as the initial—and sometimes only—investigation into their gastrointestinal symptoms. For many patients, these agents are prescribed for years with little concern for their long-term adverse effects.

Unfortunately, no drug is without risks and even agents that seem relatively harmless, such as PPIs, carry the possibility of being dangerous when used inappropriately. It is important to continually check with your doctor about your current drug regimen to see whether the benefits of your medications continue to outweigh their risks.