Review article: infective complications of therapeutic gastric acid inhibition

Abstract

SUMMARY Gastric acid secretion has a non‐specific bactericidal action which contributes to gastrointestinal defence mechanisms against micro‐organisms. Therapeutic inhibition of acid secretion with histamine H2 receptor antagonists and proton pump inhibitors might therefore be expected to predispose to infection. This article reviews clinical reports of infection occurring during therapeutic gastric acid inhibition, and assesses the risk of infection incurred by such treatment. Non‐typhoid salmonelloses, Campylobacter infections, local candidiasis, and possibly Strongyloides hyperinfections may be more prevalent after acid inhibitory treatment, but concurrent impairment of other gastrointestinal defence mechanisms may be necessary to permit infection.

Adverse Effects of Long-Term Proton Pump Inhibitor Therapy

“…The strongest evidence for parasitic infections associated with hypochlorhydria is for Giardiasis and Strongyloidiasis [107]. Although Giardiasis is the most common protozoal infection of the small intestine worldwide, gastric infection is very rare, with less than 100 cases reported in the literature.…”

Adverse effects of proton pump inhibitor drugs: clues and conclusions

“…Following the famous admonition of Sir Arthur Hurst to the British Government in 1934, that people with hypochlorhydria should not be sent to the tropics, there have been numerous previous papers on the risks of infection associated with hypochlorhydria caused by disease, surgery or therapeutic agents [13]. It is effective against sensitive organisms, Adverse effects of proton pump inhibitors McCarthy 625 preventing infection unless the inoculum is large, acidresistant, highly virulent or host defenses are impaired.…”

Influence of Gastric Acid on Susceptibility to Infection with Ingested Bacterial Pathogens

“…Hypochlorhydria (4 Ͻ pH Ͻ 7) (3) and achlorhydria (pH Ͼ 7) can be acquired or iatrogenic. Acquired hypochlorhydria can result from atrophic gastritis or be induced by malnutrition (10,15). Iatrogenic hypochlorhydria can be caused by gastric surgery or by drugs that inhibit acid secretion (18).…”