Treating GERD Symptoms May Facilitate Pneumonia

Summarized by Robert W. Griffith, MD
December 22, 2004

Introduction

Indigestion, or dyspepsia, affects at least 20% to 40% of the general population, and most victims take something to reduce acidity - an acid-suppressing drug. Acid suppressants are of two types: H2-receptor blockers, like Tagamet^® (cimetidine), Pepcid^® (famotidine) and Zantac^® (ranitidine), or a proton-pump inhibitor, like Prilosec^® (omeprazole) and Nexium^® (esomeprazole). It's now emerged that these drugs, apart from the benefit they have on the indigestion symptoms, may have an unexpected side effect - an increased risk of the patient acquiring pneumonia. Decreasing the acidity of the stomach contents lowers their ability to destroy any harmful bacteria that may be swallowed. A Dutch study reporting the connection between acid-suppressing drug use and pneumonia has been published in the Journal of the American Medical Association, and we summarize the findings here.

What was done

There's a large database of family practice records in Rotterdam, Netherlands, that includes information on roughly 500,000 patients. All the records maintained are anonymous. Between 1995 and 2002 all records were analyzed that included data to characterize the patient, provide drug usage information, and confirm any diagnosis of pneumonia.

Then, a group was formed of all patients who started a course of acid-suppressing drugs for the first time and who didn't take an antibiotic to eliminate the stomach bacterium Helicobacter pylori at the same time. People who never used an acid suppressant before or during the study period formed a 'non-exposed' control group.

Reported cases of pneumonia were carefully evaluated, requiring proof in the form of X-rays or sputum culture. Without this evidence, pneumonia was classified as probable, possible, or 'no pneumonia'.

For analysis, up to 10 controls (i.e. people not exposed to acid-suppressing drugs) were matched to each case of pneumonia, depending on the family practice concerned, age, gender, and date of disease onset.

What the analyses showed

There were 5551 cases of pneumonia (certain or probable) diagnosed among the 364,683 patient records. During the study - each person was followed for an average of 2.7 years - 19,459 patients started on acid-suppressing drugs for the first time; amongst these, 185 developed pneumonia while taking the drug, and 292 after stopping acid-suppressant use. Using these numbers, the investigators calculated that acid-suppressing drug users developed pneumonia 4.5 times more often than non-users. For Tagamet/Pepcid/Zantac-type acid suppressants the likelihood was 4.3 times, and for Nexium/Prilosec it was 4.7 times.

For those who were currently using acid-suppressing drugs, compared with those who had taken them but then stopped, there was an increased risk of 1.6 times (Tagamet-type) or 1.9 times (Nexium-type). In the case of proton-pump inhibitors, the risk was greater with higher drug doses.

What this means

The study shows that current use of acid-suppressing drugs increases the risk of developing pneumonia. Decreasing the acidity of stomach acid (i.e. raising its pH) allows survival of bacteria and viruses in the stomach which can then 'colonize' the esophagus and possibly the back of the throat, and, from there, get to the lungs.

The acid-suppressing drugs are very effective for treating gastric symptoms. The greater-than-4-fold increased risk of developing pneumonia with their use is not nearly as serious as it sounds, because the overall risk of getting pneumonia is quite small. However, it's as well for people taking these drugs to be aware of the possibility, especially if they are at an increased risk of infection due to chronic illness, age, or suppression of their immune system for any reason.

Once again, this is a reminder that even the safest of drugs can have unlikely side effects. Don't take 'em unless you really need 'em!

Source

• Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. RJF. Laheij, MCJM. Sturkenboom, R-J. Hassing,  et al., JAMA, 2004, vol. 292, pp. 1955--1960

Related Links
GERD is More Common If You're Overweight
GERD or GORD, It's Still a Pain

Please take a moment to give us your comments. For questions about Health matters you may check our "Questions & Answers" Portal and Service.