Will Proton Pump Inhibitors Lead to a Higher Risk of COVID-19 Infection and Progression to Severe Disease? A Meta-analysis

Yan, Cairong; Chen, Yue; Sun, Chenyu; Ahmed, Mashrafi; Bhan, Chandur; Cheng, Ce; Hu, Lei; Guo, Zhichun; Yang, Hongxia; Cao, Chenyu; Ji, Ziwei; Yan, Ye; Zuo, Yijing; Sun, Yiceng; Li, Yao; Zhou, Qin

doi:10.1101/2020.12.25.20248860

Cited by 5 publications

(4 citation statements)

References 36 publications

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“…We showed here that the previous use of PPIs is associated with increased risk of death from COVID-19. Such association is supported by a meta-analysis of eight studies ( 30 ) that showed that previous use of PPIs increases the risk of progression to severe COVID-19. Almario et al ( 31 ) recently described that individuals taking PPIs had greater chances for testing positive for COVID-19 when compared to those not using PPIs.…”

Section: Discussionmentioning

confidence: 86%

Acid pH Increases SARS-CoV-2 Infection and the Risk of Death by COVID-19

et al. 2021

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect a broad range of human tissues by using the host receptor angiotensin-converting enzyme 2 (ACE2). Individuals with comorbidities associated with severe COVID-19 display higher levels of ACE2 in the lungs compared to those without comorbidities, and conditions such as cell stress, elevated glucose levels and hypoxia may also increase the expression of ACE2. Here, we showed that patients with Barrett's esophagus (BE) have a higher expression of ACE2 in BE tissues compared to normal squamous esophagus, and that the lower pH associated with BE may drive this increase in expression. Human primary monocytes cultured in reduced pH displayed increased ACE2 expression and higher viral load upon SARS-CoV-2 infection. We also showed in two independent cohorts of 1,357 COVID-19 patients that previous use of proton pump inhibitors is associated with 2- to 3-fold higher risk of death compared to those not using the drugs. Our work suggests that pH has a great influence on SARS-CoV-2 Infection and COVID-19 severity.

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Section: Discussionmentioning

confidence: 86%

Acid pH Increases SARS-CoV-2 Infection and the Risk of Death by COVID-19

et al. 2021

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“…Similarly, previous consumption of PPIs has been associated with an increased risk of COVID-19-related death, as demonstrated by Almario, Chey and Spiegel [ 118 ] . A meta-analysis of 8 studies [ 119 ] showing that prior PPI use raises the likelihood of COVID-19 development to a severe manifestation corroborated this association. In addition, PPI users had a greater likelihood of testing positive for COVID-19 than non-users Almario, Chey and Spiegel.…”

Section: Covid-19 and Lpr And Potential Aspirationmentioning

confidence: 87%

Critical appraisal of how COVID-19 infection and imposed lockdowns have impacted gastroesophageal reflux: A review

Al-Momani,

Aolymat,

Al Haj Mahmoud

2024

Medicine

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Previous literature has demonstrated that COronaVIrus Disease of 2019 (COVID-19) impacts an individual gastrointestinal tract (GIT), causing symptoms like nausea, diarrhea, and loss of appetite. Severe acute respiratory syndrome coronavirus RNA has been discovered in the stool of infected individuals in earlier research. It was discovered that severe acute respiratory syndrome coronavirus was significantly expressed in the GIT, indicating that the virus can also infect the digestive system. Angiotensin-converting enzyme 2 functions as the viral receptor. The chronic illness known as gastroesophageal reflux disease (GERD) is typified by frequent reflux of stomach acid into the esophagus. By triggering the sensitized esophageal-bronchial neuronal circuit or aspirating into the airways (microaspiration), GER exacerbates respiratory diseases. Aspiration is a well-known risk to be considered when treating patients in intensive care units. Strong genetic correlations have been identified between COVID-19 infection and GERD susceptibility, suggesting a shared genetic basis for both conditions. Nonetheless, even though GERD, extraesophageal reflex, and COVID-19 have a number of significant risk factors and exhibit similar symptoms, the relationship between these illnesses has not yet been examined in depth. This review is the first of its kind to critically examine the association between the COVID-19 epidemic and GER and its associated diseases. The key objective of this work is to promote the creation of prevention plans, treatment plans, and guidelines while also enhancing and optimizing our understanding of the relationship between COVID-19 and GERs.

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“…In the Cunye et al [56] analysis (online publication without a peer-review) of eight studies with more than 268,683 subjects, PPI use did not influence the risk of SARS-CoV-2 infection or mortality risk of COVID-19 patients, but the risk of severe disease (OR 1.54) and secondary infection (OR 4.33) was increased. However, the authors stress the need of more high-quality studies to further clarify the relationship.…”

Section: Impact Of Ppi Use In Covid-19 Pandemic -Evidence From the Re...mentioning

confidence: 97%

The Proton Pump Inhibitors Use and COVID-19 from Prior to Vaccination Perspective: A Review

Ksiądzyna

Szeląg²

2022

Dig Dis

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Background: The coronavirus infectious disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has been a huge challenge affecting, directly or indirectly, human race worldwide. Many COVID-19-related risk factors have been identified. Various drugs, including proton pump inhibitors (PPIs), have been claimed to increase the risk of acquiring or effecting the outcome of COVID-19 prior to the availability of vaccines. The aim of this review is to summarize the uncertain role of PPIs use on the SARS-CoV-2 infection and COVID-19 clinical course, including both some well-established and presumptive indications to these potent inhibitors of gastric acid secretion, before vaccinations against COVID-19 were implemented on a massive scale. Summary: Although iatrogenic hypochlorhydria alters human microbiota and impairs the non-specific innate immunity increasing the likelihood of gastrointestinal and pulmonary infections, published data on the relationship between SARS-CoV-2 positivity and clinical manifestations of COVID-19 is quite inconclusive. On the contrary, the beneficial role of PPIs use in the prevention of the upper gastrointestinal bleeding, particularly in at-risk patients receiving dual antiplatelet treatment and/or concomitant anticoagulation constituting a significant proportion of COVID-19 patients, has been well-documented. Furthermore, PPIs have been marked as a potential antiviral remedy, just like many already existing re-purposed drugs, that merit further studies in search of successful anti-COVID-19 pharmacotherapy. Key messages: The controversial role of PPIs on the SARS-CoV-2 infection and COVID-19 severity propounded in the past should not prevent the use of these potent inhibitors of gastric acid secretion in well-established clinical indications.

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Will Proton Pump Inhibitors Lead to a Higher Risk of COVID-19 Infection and Progression to Severe Disease? A Meta-analysis

Cited by 5 publications

References 36 publications

Acid pH Increases SARS-CoV-2 Infection and the Risk of Death by COVID-19

Acid pH Increases SARS-CoV-2 Infection and the Risk of Death by COVID-19

Critical appraisal of how COVID-19 infection and imposed lockdowns have impacted gastroesophageal reflux: A review

The Proton Pump Inhibitors Use and COVID-19 from Prior to Vaccination Perspective: A Review

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