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Stomach Acid Drugs May Raise Pneumonia Risk

Risk From Acid-Suppressing Drugs Greatest in Frailest Patients

How Acid-Suppressing Drugs Promote Infection

How might these drugs cause infection? Exactly the same way they work: by suppressing stomach acid. While it sounds bad, stomach acid is the body's first line of defense against swallowed germs. The acid can kill bacteria and viruses that cause pneumonia.

The bodies of healthy people have plenty of other ways to fight germs. But elderly people and those with chronic diseases need all the germ-fighting help they can get. This is exactly who is at most risk for pneumonia when using acid-suppressing drugs.

Laheij's team found the risk of severe pneumonia to be highest in the elderly. Children and people with weakened or suppressed immune systems were also at higher risk. And there was a greater risk of pneumonia in users of acid-suppressing drugs who had asthma or lung disease.

It's not clear how germs from the stomach get into the lungs to cause pneumonia. But the new link to pneumonia means doctors will keep a closer eye on patients who take acid-suppressing drugs, says lung specialist Greg Martin, MD, MSc. Martin teaches pulmonary, allergy, and critical care medicine at Emory University and is director of the pulmonary clinic and the medical intensive care unit at Grady Memorial Hospital in Atlanta.

"Now doctors need to think differently about lung infections," Martin tells WebMD. "What we will do now, maybe we'll be telling people taking PPIs to take mild pneumonia symptoms more seriously. Now you say to a patient, 'Well, the fever is not that high, you are not short of breath, it is nothing major; go home and take a day off, see if you feel better.' Now, in the context of this study, if a person is taking these drugs, maybe we should be taking an X-ray to make sure they don't have pneumonia."

If you're taking acid-suppressing drugs, Martin says, it's a good idea to know the early symptoms of pneumonia:

  • Fever, usually over 100.5 degrees and up
  • Cough, especially a wet cough with phlegm production
  • Chest pain, especially on one side, that is made worse with deep breathing
  • Shortness of breath without exertion

"Fever should go with some other symptoms," Martin says. "The real pneumonia symptoms we think of are fever and cough. Shortness of breath can be another symptom, but it is not always there. And shortness of breath can have a lot of causes, so it's not an indicator of pneumonia all by itself."

Chest pain, Martin notes, can also be a sign of the kinds of stomach problems treated with acid-suppressing drugs. So can a cough, notes gastroenterologist Peura. In fact, Peura says, it's no secret that people with untreated reflux disease are at increased risk of pneumonia.

"How much more pneumonia would the patients in the Laheij study have had if they not been treated?" Peura asks. "Severe reflux can be associated with pneumonia. ... Yes, those at highest risk of pneumonia appeared to be those taking the highest doses [of acid-suppressing drugs]. But maybe that is because their reflux was more severe. Was it reflux causing the pneumonia -- in which case acid suppression with a PPI was the appropriate treatment -- or was acid suppression putting people at risk for pneumonia?"

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