November 25th, 2013
Does Suppressing Gastric Acid Cause Community-Acquired Pneumonia?
Ever since early observational studies documented an association between acid suppression and pneumonia, many clinicians have assumed this association meant causation. This intrigues me because results of numerous prospective trials that have controlled for underlying patient comorbidities have refuted any causative effect. Moreover, acid suppression does not result in a gastric environment conducive to bacterial overgrowth — the mechanism proposed in the hypothesis.
So why are more studies being conducted despite continuing results that show the same thing (acid-suppressive drugs are NOT associated with community-acquired pneumonias)?
What are your thoughts? Specifically:
- Do you believe that acid-suppressing drugs might cause pneumonia?
- If you believe this effect exists, is it the same for all agents (e.g., H2-receptor antagonists vs. PPIs)?
- Are there patients you believe to be at higher risk for this effect?
- How do you manage this issue?
Looking forward to seeing what you think.