SynthesisPloS one2012
Association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis.
Synthesis in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
61 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Magnitude and direction of the association between Clostridium difficile infection and proton pump inhibitors in adults and pediatric patients: a systematic review and meta-analysis.Journal of gastroenterology · 2018Pooled it
- Comparison of the Hospital-AcquiredGut and liver · 2017Pooled it
- Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis.World journal of gastroenterology · 2017Pooled it
- Risk factors forJournal of global health · 2017Pooled it
- Assessing the Risk of Hospital-Acquired Clostridium Difficile Infection With Proton Pump Inhibitor Use: A Meta-Analysis.Infection control and hospital epidemiology · 2016Pooled it
- The association between histamine 2 receptor antagonist use and Clostridium difficile infection: a systematic review and meta-analysis.PloS one · 2013Pooled it
- Comparing the Efficacy and Safety of Fexuprazan and Lansoprazole for the Prevention of Nonsteroidal Anti-inflammatory Drug-Induced Peptic Ulcer.Gut and liver · 2025Trial
- Trial
- A Vanished Association Between Proton Pump Inhibitors and Clostridioides Difficile Infection After Minimizing Bias.Journal of clinical medicine · 2025Article
- Association Between Antimicrobials and Pump Proton Inhibitors Consumption with the Incidence of NosocomialAntibiotics (Basel, Switzerland) · 2025Article
- Current Status of Anti-Reflux Surgery as a Treatment for GERD.Medicina (Kaunas, Lithuania) · 2024Review
- Treatment approaches to horses with acute diarrhea admitted to referral institutions: A multicenter retrospective study.PloS one · 2024Article
- Appropriateness of Proton Pump Inhibitor Prescription Evaluated by Using Serological Markers.International journal of molecular sciences · 2023Article
- Clostridioides difficile Diarrhea: An Emerging Problem in a South Indian Tertiary Care Hospital.Journal of laboratory physicians · 2021Article
- The Positive Association between Proton Pump Inhibitors and Clostridium Difficile Infection.Innovations in pharmacy · 2021Review
- Proton pump inhibitor use is associated with hip fracture development: a nationwide population-based cohort study.The Korean journal of internal medicine · 2020Article
- Review
- Article
- Guidelines forPrzeglad gastroenterologiczny · 2020Article
- Proton Pump Inhibitors in the Elderly, Balancing Risk and Benefit: an Age-Old Problem.Current gastroenterology reports · 2019Review
1 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionEmerging epidemiological evidence suggests that proton pump inhibitor (PPI) acid-suppression therapy is associated with an increased risk of Clostridium difficile infection (CDI).
methodsOvid MEDLINE, EMBASE, ISI Web of Science, and Scopus were searched from 1990 to January 2012 for analytical studies that reported an adjusted effect estimate of the association between PPI use and CDI. We performed random-effect meta-analyses. We used the GRADE framework to interpret the findings.
resultsWe identified 47 eligible citations (37 case-control and 14 cohort studies) with corresponding 51 effect estimates. The pooled OR was 1.65, 95% CI (1.47, 1.85), I(2) = 89.9%, with evidence of publication bias suggested by a contour funnel plot. A novel regression based method was used to adjust for publication bias and resulted in an adjusted pooled OR of 1.51 (95% CI, 1.26-1.83). In a speculative analysis that assumes that this association is based on causality, and based on published baseline CDI incidence, the risk of CDI would be very low in the general population taking PPIs with an estimated NNH of 3925 at 1 year.
conclusionsIn this rigorously conducted systemic review and meta-analysis, we found very low quality evidence (GRADE class) for an association between PPI use and CDI that does not support a cause-effect relationship.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.