PMID- 29163961
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220311
IS  - 2050-6406 (Print)
IS  - 2050-6414 (Electronic)
IS  - 2050-6406 (Linking)
VI  - 5
IP  - 7
DP  - 2017 Nov
TI  - The risk of Clostridium difficile infection in patients with pernicious anaemia: 
      a retrospective cohort study using primary care database.
PG  - 959-966
LID - 10.1177/2050640617695697 [doi]
AB  - BACKGROUND: Studies have found an association between proton pump inhibitor (PPI) 
      use and Clostridium difficile infection. The purpose of this study was to 
      determine whether the mechanism by which PPIs induce an increased risk of C. 
      difficile infection is supported by the same mechanism acting in another cause of 
      achlorhydria, pernicious anaemia. METHODS: Using a database of anonymised primary 
      care records between 1990 and 2013, we selected exposed patients with a diagnosis 
      of pernicious anaemia treated with vitamin B12 therapy. Each exposed patient was 
      matched by age, gender and general practice to up to 10 controls. Cox regression 
      analysis was used to estimate the hazard ratio (HR) and 95% confidence interval 
      (CI) for C. difficile infection with pernicious anaemia, adjusted for potential 
      confounders. RESULTS: We identified 45,467 exposed patients matched to 449,635 
      controls. The crude incidence rate of C. difficile infection was 1.85/1000 
      person-years for the exposed cohort and 1.09/1000 person-years for controls. 
      Patients with pernicious anaemia had a greater risk of C. difficile infection 
      than the controls (adjusted HR 1.57, 95% CI 1.40-1.76). CONCLUSIONS: Pernicious 
      anaemia patients have an increased risk of C. difficile infection. This supports 
      the theory that severe achlorhydria is the mechanism that increases the risk of 
      C. difficile infection in long-term PPI users.
FAU - Othman, Fatmah
AU  - Othman F
AD  - Department of Epidemiology and Public Health, University of Nottingham, 
      Nottingham, UK.
AD  - Department of Basic Medical Sciences, King Saud bin Abdulaziz University for 
      Health Sciences, Riyadh, Saudi Arabia.
FAU - Crooks, Colin J
AU  - Crooks CJ
AD  - Department of Epidemiology and Public Health, University of Nottingham, 
      Nottingham, UK.
FAU - Card, Timothy R
AU  - Card TR
AD  - Department of Epidemiology and Public Health, University of Nottingham, 
      Nottingham, UK.
LA  - eng
PT  - Journal Article
DEP - 20170221
PL  - England
TA  - United European Gastroenterol J
JT  - United European gastroenterology journal
JID - 101606807
PMC - PMC5676549
OTO - NOTNLM
OT  - Pernicious anaemia
OT  - achlorhydria
OT  - enteric infections
OT  - general practice
OT  - proton pump inhibitor
EDAT- 2017/11/23 06:00
MHDA- 2017/11/23 06:01
PMCR- 2017/11/01
CRDT- 2017/11/23 06:00
PHST- 2016/11/18 00:00 [received]
PHST- 2017/01/31 00:00 [accepted]
PHST- 2017/11/23 06:00 [entrez]
PHST- 2017/11/23 06:00 [pubmed]
PHST- 2017/11/23 06:01 [medline]
PHST- 2017/11/01 00:00 [pmc-release]
AID - 10.1177_2050640617695697 [pii]
AID - 10.1177/2050640617695697 [doi]
PST - ppublish
SO  - United European Gastroenterol J. 2017 Nov;5(7):959-966. doi: 
      10.1177/2050640617695697. Epub 2017 Feb 21.