Meta-analysiscited by the Tayebat archiveabstract only checked A-PPI-05 standard review
PPIs and C. difficile – meta-analysis
Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis.
Overview
Trifan A et al.. World J Gastroenterol 2017 · PMID 29085200 · DOI 10.3748/wjg.v23.i35.6500
PPI users had about twice the odds of C. difficile infection.
Does the study support the specific claim? Yes · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
CDI risk with PPIs.
- How was the study done?
Meta-analysis.
- How many people, animals or samples were studied?
56 studies.
- What was actually found?
Higher odds.
- How large was the observed effect?
OR 1.99.
- What do the results mean in everyday life?
Gut infection risk is a real concern.
- What are the study's limitations?
Heterogeneity, publication bias.
- What does it say about Elawady's specific claim?
Supports.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Exact size; causality.
Scientific in-depth review
1. Full reference
- Authors
- Trifan A, Stanciu C, Girleanu I, Stoica OC, Singeap AM, Maxim R, Chiriac SA, Ciobica A, Boiculese L
- Journal
- World J Gastroenterol
- Year
- 2017
- Identifier
- PMID 29085200 DOI 10.3748/wjg.v23.i35.6500 · PMC5643276
- Verification
- verified – PubMed E-utilities efetch, 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Conflict-of-interest statement: The authors deny any conflict of interest.
2. Research question
Is PPI therapy associated with Clostridium difficile infection?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis of case-control and cohort studies
- Population
Adults in 56 observational studies
- Country
Multinational
- Period
1990–March 2017
- Sample size
56 studies, 356,683 patients
- Inclusion and exclusion criteria
see abstract
4. Methods and endpoints
- Exposure / intervention
PPI use
- Comparator
Non-use
- Endpoints
CDI
- Statistical methods
Random-effects pooled ORs; NOS quality; funnel plot
5. Actual results
- Results
Pooled OR 1.99 (1.73–2.30); case-control 2.00; cohort 1.98; I² 85.4%; publication bias (P=0.002).
- Absolute risks
not reported in abstract
- Authors' conclusion
PPI use is associated with increased CDI risk; high-quality prospective studies needed to assess causality.
6. Strengths
- Large number of studies
- Consistent across subgroups
7. Weaknesses
- Observational primary studies
- High heterogeneity
- Publication bias
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
AMSTAR-2-oriented: comprehensive search, but observational inputs, heterogeneity and publication bias.
9. Assessment of the statistical interpretation
See results.
10. Relevance to the specific claim
11. Independent contrary findings
COMPASS: CDI doubled but n.s. with 13 events.
12. Transferability to Germany and Europe
High: European (Swedish, UK, Dutch, German) data show similar associations; PPIs are widely used in Germany.
13. Overall methodological judgement
Consistent association, causality probable but magnitude uncertain.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | correctly reported |
14. Open questions
15. Linked fact checks
Use by the Tayebat archive
Note: according to the archive, the studies were compiled by the archive operators. Whether Dr. Elawady himself cited this study is not established.
- What the archive says about the study
Listed in the archive bibliography of the acid-blockers rule without its own interpretation; used implicitly to support the rule summary ('long-term suppression turns against the body: CKD, bacterial overgrowth, C. difficile, pneumonia, B12 and magnesium deficiency, hip fractures, microbiome change, excess mortality').
- A. What was actually studied?
Is PPI therapy associated with Clostridium difficile infection?
- B. What did the authors find?
Pooled OR 1.99 (1.73–2.30); case-control 2.00; cohort 1.98; I² 85.4%; publication bias (P=0.002).
- C. What conclusions do the authors themselves draw?
PPI use is associated with increased CDI risk; high-quality prospective studies needed to assess causality.
- D. What does the archive derive from it?
Supports the C. difficile part of the summary.
- E. Is this derivation scientifically justified?
Yes as association; size uncertain.
- Adequacy of the interpretation (by the archive)
- correctly reported