Editorials

Proton pump inhibitors and community acquired pneumonia

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6041 (Published 17 November 2016) Cite this as: BMJ 2016;355:i6041
  1. Kristian B Filion, assistant professor1 2
  1. 1Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
  2. 2Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
  1. kristian.filion{at}mcgill.ca

The observed link is probably due to protopathic bias and confounding by indication

Concerns about proton pump inhibitors (PPIs) and the risk of community acquired pneumonia initially arose in 2004 after the publication of a nested case-control study,1 in which the risk of community acquired pneumonia was significantly higher among current users of PPIs than among those who had discontinued use. This finding was supported by a strong biological rationale: acid suppression may result in bacterial overgrowth and an increased risk of bacterial aspiration. Several observational studies and corresponding meta-analyses have subsequently been conducted.2 3 The most recent meta-analysis found that PPIs were associated with an increased risk of community acquired pneumonia (pooled estimate 1.49, 95% confidence interval 1.16 to 1.92; I2=99.2%).3 Although formal meta-analysis of these data is probably inappropriate given the presence of substantial heterogeneity, a qualitative review of the same data also suggests that PPI users are at an increased risk of community acquired pneumonia.

In The BMJ (doi:10.1136/bmj.i5813), Othman and colleagues report the …

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