SynthesisJournal of gastroenterology2018
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.
Synthesis in Journal of gastroenterology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 29 papers, 3 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
29 citing papers in PubMed, 3 syntheses or guidelines pooled it, 88 citations in OpenAlex.
- Proton pump inhibitors are not associated with an increased risk ofGut microbes · 2025Pooled it
- Effect of potassium-competitive acid blockers on human gut microbiota: a systematic review and meta-analysis.Frontiers in pharmacology · 2023Pooled it
- Risk factors for Clostridioides difficile infection in children and adolescents with inflammatory bowel disease: a systematic review and meta-analysis.World journal of pediatrics : WJP · 2022Pooled it
- Prenatal and/or childhood acid-suppressive medication use and risk of serious infections in children: A retrospective analysis of Taiwanese medical claims data.BMC medicine · 2026Article
- Proton Pump Inhibitor Use for Gastroprotection and Stress Ulcer Prophylaxis Does Not Increase the Risk ofJournal of clinical medicine · 2026Review
- Balancing therapeutic benefits and hidden risks of proton pump inhibitors in pediatric practice: a narrative review and update.Clinical and experimental pediatrics · 2026Article
- A Vanished Association Between Proton Pump Inhibitors and Clostridioides Difficile Infection After Minimizing Bias.Journal of clinical medicine · 2025Article
- Proton Pump Inhibitor Use and Risk of Clostridioides difficile Infection: An Umbrella Review of 11 Meta-Analyses.Cureus · 2025Review
- Real-World Safety Profile of Proton Pump Inhibitors in Infants as Reported in the FDA Adverse Event Reporting System (FAERS): Tiny Tummies, Key Decisions.Pharmaceuticals (Basel, Switzerland) · 2025Article
- Potential Risks Associated With Long-term Use of Proton Pump Inhibitors and the Maintenance Treatment Modality for Patients With Mild Gastroesophageal Reflux Disease.Journal of neurogastroenterology and motility · 2024Review
- Proton Pump Inhibitors and Oral-Gut Microbiota: From Mechanism to Clinical Significance.Biomedicines · 2024Review
- Impact of pharmacist-evaluated clinical decision support system alerts on potentially missing or inappropriately prescribed proton pump inhibitors at hospital discharge: a retrospective cross-sectional study.International journal of clinical pharmacy · 2024Article
- Review
- The combined effect of systemic antibiotics and proton pump inhibitors on Clostridioides difficile infection and recurrence.The Journal of antimicrobial chemotherapy · 2024Article
- Vonoprazan-associatedTherapeutic advances in drug safety · 2024Article
- Effect of proton pump inhibitors in infants with esophageal atresia on the gut microbiome: a pilot cohort.Gut pathogens · 2022Article
- 2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease.Journal of neurogastroenterology and motility · 2021Review
- Potentially inappropriate medications in Chinese older adults: a comparison of two updated Beers criteria.International journal of clinical pharmacy · 2021Article
- The Positive Association between Proton Pump Inhibitors and Clostridium Difficile Infection.Innovations in pharmacy · 2021Review
- Review
Corrections and comments
- Erratum issued
Authors and funding
6 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundClostridium difficile infection (CDI) is a cause of increased morbidity and health care costs among hospitalized patients. Proton pump inhibitors (PPIs) are mainly used for the treatment of acid-related upper gastrointestinal diseases. The aim of the study was to assess the risks associated with initial and recurrent CDI in adult and pediatric patients treated with PPIs.
methodsA systematic search was performed using PubMed (Medline), Embase, and Web of Science with the following search terms: ("proton pump inhibitor," "PPI," or "acid suppression") AND ("infection," "diarrhea," "diarrhoea," "colitis," or "disease") AND ("Clostridium difficile"). Meta-analysis was performed using Revman5.3 software. Pooled odds ratios (ORs) presented as standard plots with 95% confidence intervals (CIs) were determined.
resultsSixty-seven eligible studies were selected. PPI use was significantly associated with risk of CDI (OR 2.34, 95% CI 1.94-2.82; P < 0.00001). Pooled data from twelve studies demonstrated a significant association between PPI use and recurrent CDI (OR 1.73, 95% CI 1.39-2.15; P = 0.02). Subgroup analysis revealed significant associations between PPI use and an increased incidence of CDI among adult (OR 2.30, 95% CI 1.89-2.80; P < 0.00001) and pediatric (OR 3.00, 95% CI 1.44-6.23; P < 0.00001) patients.
conclusionsPPI use was associated with CDI in adult and pediatric patients, and with recurrent CDI. Although many risk factors are associated with the occurrence and recurrence of CDI, consideration should be given to not administering PPIs at any age if they are unnecessary.
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What OpenQuestion holds
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.