Gastric Acid and Enteric Infections: Souring on the Use of PPIs

Excerpt

Gastric acid is important for maintaining homeostasis within the gastrointestinal tract by facilitating protein digestion and the absorption of dietary calcium and iron, and by reducing the counts of enteric infectious agents. This defense mechanism is most important for persons living in or visiting regions of the world where personal and food hygiene are substandard. Reductions in gastric acid secretion associated with nutritional deficiencies in developing countries are partially responsible for the high local rates of infectious diarrhea and cholera. There is growing scientific evidence that pharmacologic reductions in gastric acid concentrations, in particular by proton-pump inhibitors (PPIs), approximately doubles the risk of acquiring enteric infection from infectious pathogens present in contaminated foods that are ingested [1]. The successes achieved in the PPI era regarding acid-related disorders including reflux esophagitis has led to overuse of this drug class. The problem of overuse has increased since PPIs became available over the counter without prescription. Patients are often given a PPI on admission to the hospital as a routine measure, and in many cases the drug is continued after discharge. Primary care physicians and the general public should be advised on the proper long-term use of PPIs [2]. …