Hassing Robert-Jan, Verbon Annelies, de Visser Herman, Hofman Albert, Stricker Bruno H
Department of Epidemiology, Erasmus Medical Centre, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
Eur J Epidemiol. 2016 Oct;31(10):1057-1063. doi: 10.1007/s10654-016-0136-8. Epub 2016 Mar 10.
An association between proton pump inhibitor (PPI) therapy and bacterial gastroenteritis has been suggested as well as contradicted. The aim of this study was to examine the association between the use of PPIs and occurrence of bacterial gastroenteritis in the prospective Rotterdam Study. The Rotterdam Study is a population-based cohort study among 14,926 subjects aged 45 years and older with up to 24 years of follow-up. Analyses were performed with a generalized estimating equations method in participants who handed-in a diagnostic stool sample. Furthermore, a nested case-control analysis was performed using the total cohort as a reference group. A bacterial microorganism was isolated in 125 samples, whereas 1174 samples were culture negative. In the generalized estimating equations analysis, we found that participants with a bacterial gastroenteritis were more likely than controls to be current users of PPIs (adjusted OR 1.94; 95 % CI 1.15-3.25). Different sensitivity analyses did not change this result. A considerably higher effect was observed (adjusted OR 6.14; 95 % CI 3.81-9.91), using the total cohort as a reference in a nested case-control analysis. Current PPI therapy is associated with an increased risk of bacterial gastroenteritis. However, by reducing the risk of selection and information bias in our study design, we demonstrated that the effect is lower than previously assumed.
质子泵抑制剂（PPI）治疗与细菌性肠胃炎之间的关联既有人提出，也有人予以反驳。本研究的目的是在鹿特丹前瞻性研究中检验PPI的使用与细菌性肠胃炎发生之间的关联。鹿特丹研究是一项基于人群的队列研究，研究对象为14926名45岁及以上的受试者，随访时间长达24年。对提交了诊断性粪便样本的参与者采用广义估计方程法进行分析。此外，以整个队列作为参照组进行了巢式病例对照分析。125份样本中分离出了一种细菌微生物，而1174份样本培养呈阴性。在广义估计方程分析中，我们发现患有细菌性肠胃炎的参与者比对照组更有可能是PPI的当前使用者（校正比值比1.94；95%可信区间1.15 - 3.25）。不同的敏感性分析并未改变这一结果。在巢式病例对照分析中，以整个队列作为参照时，观察到的效应要高得多（校正比值比6.14；95%可信区间3.81 - 9.91）。当前的PPI治疗与细菌性肠胃炎风险增加相关。然而，通过在我们的研究设计中降低选择和信息偏倚的风险，我们证明该效应比之前设想的要低。
