Patients With Clostridium difficile Infections Should Have Need For Gastric Acid Suppression Reassessed Interview with:

Sahil Khanna,

Dr. Sahil Khanna

Sahil Khanna, M.B.B.S. MS
Division of Gastroenterology and Hepatology
Mayo Clinic, Rochester, Minnesota What is the background for this study? What are the main findings?

Response: Clostridium difficile infection (CDI) is the most common cause of hospital-acquired diarrhea and has recently shown increasing incidence especially in the community. Novel risk factors for CDI development include the use of gastric acid suppression medication, presence of systemic comorbid conditions, C difficile carriage in water and food sources, amongst others.

Gastric acid suppression medications such as proton-pump inhibitors (PPIs) and histamine-2 receptor blockers (H2Bs) are commonly prescribed and consumed over the counter for gastroesophageal reflux disease, peptic ulcer disease, or functional dyspepsia, but they are also sometimes prescribed for unnecessary indications, which leads to overuse of these medications. Recurrent CDI after a primary infection is a major problem, with the risk being as high as 50% to 60% after 3 or more Clostridium difficile infections. Data on the association between acid suppression and recurrent CDI are conflicting and therefore we performed a systematic review and meta-analysis to study the association between the use of gastric acid suppression medications and the risk of recurrent CDI. What should readers take away from your report?

Response: Patients with Clostridium difficile infection should be re-evaluated to assess the necessity of use of gastric acid suppression medications to prevent the risk of recurrent CDI. Decreasing unnecessary use of these medications without a proper indication may help reduce recurrent CDI and health care costs. What recommendations do you have for future research as a result of this study?

Response: These findings should be interpreted with caution, as they may be confounded due to observational nature of the individual studies. A randomized controlled trial evaluating the effect of continuing the use of acid suppression medications versus stopping them in patients with no serious indication for their use might be helpful in assessing the true relationship between acid suppression medications and the risk of recurrent CDI. Thank you for your contribution to the community.


Tariq R, Singh S, Gupta A, Pardi DS, Khanna S. Association of Gastric Acid Suppression With Recurrent Clostridium difficile InfectionA Systematic Review and Meta-analysis. JAMA Intern Med. Published online March 27, 2017. doi:10.1001/jamainternmed.2017.0212

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on March 29, 2017 by Marie Benz MD FAAD