Meta-analysis: proton pump inhibitor use and the risk of community-acquired pneumonia
Version of Record online: 4 MAR 2010
© 2010 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 31, Issue 11, pages 1165–1177, June 2010
How to Cite
JOHNSTONE, J., NERENBERG, K. and LOEB, M. (2010), Meta-analysis: proton pump inhibitor use and the risk of community-acquired pneumonia. Alimentary Pharmacology & Therapeutics, 31: 1165–1177. doi: 10.1111/j.1365-2036.2010.04284.x
- Issue online: 3 MAY 2010
- Version of Record online: 4 MAR 2010
- Publication data Submitted 8 January 2010 First decision 8 February 2010 Resubmitted 25 February 2010 Accepted 26 February 2010 Epub Accepted Article 4 March 2010
Aliment Pharmacol Ther 31, 1165–1177
Background Observational studies examining the association between proton pump inhibitor (PPI) use and risk of community-acquired pneumonia are conflicting.
Aim To assess systematically the association between risk of community-acquired pneumonia and PPI use in adults.
Methods We searched MEDLINE, EMBASE and CINAHL databases between 1988 and January 2010. Two reviewers independently selected studies based on eligibility criteria and extracted data. Included studies evaluated adults (≥18 years) who took PPIs as an out-patient. The primary outcome was community-acquired pneumonia. Only observational studies with a comparison arm were included.
Results Over 2600 citations were reviewed. Six studies were included. All were nested case-control studies. Meta-analysis found an increased risk of community-acquired pneumonia associated with PPI use [OR 1.36 (95% CI 1.12–1.65)]; significant heterogeneity remained (I2 92%, P < 0.001). In exploratory subgroup analysis, short duration of use was associated with an increased odds of community-acquired pneumonia [OR 1.92 (95% CI 1.40–2.63), I2 75%, P = 0.003], whereas chronic use was not [OR 1.11 (95% CI 0.90–1.38), I2 91%, P < 0.001], a significant interaction (P < 0.005).
Conclusions Heterogeneity precluded interpretation of the summary statistic. Exploratory analysis revealed that duration of PPI use may impact the risk of community-acquired pneumonia, a finding that should be explored in future studies.