Q J Med 2000; 93: 175-181
© 2000 Association of Physicians
Gastric acid suppression does not promote clostridial diarrhoea in the elderly
1 From the Department of Geriatric Medicine, University of Wales College of Medicine, Llandough Hospital, Penarth, Cardiff, Departments of Microbiology, and 2 Care of the Elderly, Morriston Hospital, Swansea, and 3 Department of Statistics and Medical Computing, University of Wales College of Medicine, Cardiff, UK
Received 17 September 1999 and in revised form 12 January 2000
Gastric acid prevents bacterial colonization of the stomach and suppression of its secretion might predispose to Clostridium difficile (CD) diarrhoea. We retrospectively studied elderly patients admitted to medical wards of an acute hospital to determine whether the incidence of CD diarrhoea was greater among those previously treated with gastric acid suppressants. From records of stool CD toxin tests undertaken in 1995 and 1996, we found 126 cases with positive results, and selected 126 controls with negative results. Information about pre-morbid illness, predisposing factors for CD and medication received in the preceding 16 weeks was obtained from case-notes. A greater number of CD positive cases had received antibiotics such as Cefuroxime, ciprofloxacin or macrolides with or without metronidazole, were more severely disabled, required assistance for feeding, or had hypoalbuminaemia before the onset of diarrhoea. A greater number of controls had received lactulose, suggesting either that its laxative effect resembled CD infection prompting frequent stool tests, or that it offered protection against CD in this group. Both groups were similar for the use of proton-pump inhibitors or H2-receptor antagonists, suggesting that susceptible elderly patients are not more likely to develop CD diarrhoea after receiving gastric acid suppression therapy.
Address correspondence to Professor K.W. Woodhouse, Department of Geriatric Medicine, Academic Centre, Llandough Hospital, Penarth, Vale of Glamorgan CF64 2XX
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