Meta-analysiscited by the Tayebat archiveabstract only checked A-PPI-06 standard review
PPIs and C. difficile in hospital
Clostridium difficile-associated diarrhea and proton pump inhibitor therapy: a meta-analysis.
Overview
Janarthanan S et al.. Am J Gastroenterol 2012 · PMID 22710578 · DOI 10.1038/ajg.2012.179
Pooled risk about 1.7-fold higher with PPIs.
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?
CDAD with PPIs.
- How was the study done?
Meta-analysis.
- How many people, animals or samples were studied?
23 studies.
- What was actually found?
Higher incidence.
- How large was the observed effect?
RR ≈1.69.
- What do the results mean in everyday life?
Infection risk.
- What are the study's limitations?
Observational; overlap.
- 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?
Causation.
Scientific in-depth review
1. Full reference
- Authors
- Janarthanan S, Ditah I, Adler DG, Ehrinpreis MN
- Journal
- Am J Gastroenterol
- Year
- 2012
- Identifier
- PMID 22710578 DOI 10.1038/ajg.2012.179
- Verification
- verified – PubMed E-utilities efetch, 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract
2. Research question
Association between PPIs and C. difficile-associated diarrhoea in hospitalised patients
3. Study design and population
- Study design
- Meta-analysis – Meta-analysis of observational studies
- Population
Hospitalised patients
- Country
Multinational
- Period
1990–2010
- Sample size
23 studies, ~300,000 patients
- Inclusion and exclusion criteria
see abstract
4. Methods and endpoints
- Exposure / intervention
PPI use
- Comparator
Non-use
- Endpoints
CDAD
- Statistical methods
Random-effects; Begg/Egger; trim-and-fill
5. Actual results
- Results
Summary risk estimate 1.69 (1.395–1.974); cohort 2.31 (1.72–3.10); case-control 1.48 (1.25–1.75).
- Absolute risks
not reported in abstract
- Authors' conclusion
Sufficient evidence to suggest PPIs increase CDAD incidence; more prudent use recommended.
6. Strengths
- Hospital focus
7. Weaknesses
- Observational inputs
- Only Medline/PubMed searched
- Overlaps with A-PPI-05
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
Overlapping primary studies with A-PPI-05; not independent confirmation.
9. Assessment of the statistical interpretation
See results.
10. Relevance to the specific claim
11. Independent contrary findings
Overlap with A-PPI-05.
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 with A-PPI-05; not independent.
| 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?
Association between PPIs and C. difficile-associated diarrhoea in hospitalised patients
- B. What did the authors find?
Summary risk estimate 1.69 (1.395–1.974); cohort 2.31 (1.72–3.10); case-control 1.48 (1.25–1.75).
- C. What conclusions do the authors themselves draw?
Sufficient evidence to suggest PPIs increase CDAD incidence; more prudent use recommended.
- D. What does the archive derive from it?
Supports C. difficile claim.
- E. Is this derivation scientifically justified?
Yes as association.
- Adequacy of the interpretation (by the archive)
- correctly reported