Dr. Starpoli blog on GI disorders

Much Greater Risk for Clostridium difficle with Reflux Therapy

Written by Anthony Starpoli | Oct 7, 2011 10:47:00 PM

In a retrospective study from Japan, the chronic use of proton pump inhibitors (PPIs), often used in the treatment of GERD, was found to be associated with a greater than 3-fold increased risk of developing Clostridium difficile–associated diarrhea (CDAD), Takatoshi Kitazawa, MD, assistant professor at Teikyo University in Tokyo, Japan, reported during a poster session at the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy.

These findings add to the growing body of information about the potential long-term concerns of chronic proton pump inhibitor use.  More structured, prospective, randomized studies are needed to accurately examine the relationship between PPI use and disturbances in mineral metabolism, risk of bone fracture, drug interactions as well as the aforementioned increased risk of this dreaded infectious diarrhea.

These realizations about the adverse effects of PPI warrant more consideration to antireflux procedures in appropriately selected patients who suffer from chronic GERD.Current thinking in third management involves using the least effective dose of acid suppression therapy. Sometimes we can switch from proton pump inhibitor therapy. Two medication's called H2 blockers such as famotidine. There's no question that the reduction of acid in the gastrointestinal track cause a disruption in the Microbiome and allows for the overgrowth of these organisms. Patient to our suffering from recurrent infection as a result of these drugs may be considered for antireflux procedures as an alternative. These procedures can include transoral incisionless fundoplication or the Stretta.  Current thinking in third management involves using the least effective dose of acid suppression therapy. Sometimes we can switch from proton pump, inhibitor therapy to medication's called H2 blockers such as famotidine. There's no question that the reduction of acid in the gastrointestinal tract causes a disruption in the Microbiome and allows for the overgrowth of these organisms. Patient who are suffering from recurrent infection as a result of these drugs may be considered for anti-reflux procedures as an alternative. These procedures can include transoral incisionless fundoplication (TIF) or the Stretta procedure.