Meta-analysiscited by the Tayebat archiveabstract only checked A-PPI-07 standard review
Acid blockers and pneumonia
Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis.
Overview
Eom CS et al.. CMAJ 2011 · PMID 21173070 · DOI 10.1503/cmaj.092129
PPI users had 27% higher odds of pneumonia in observational studies, with large differences between studies.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Pneumonia risk.
- How was the study done?
Meta-analysis.
- How many people, animals or samples were studied?
31 studies.
- What was actually found?
Possible association.
- How large was the observed effect?
OR 1.27.
- What do the results mean in everyday life?
Small possible risk.
- What are the study's limitations?
Heterogeneity.
- What does it say about Elawady's specific claim?
Partly supports.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Causation for PPIs.
Scientific in-depth review
1. Full reference
- Authors
- Eom CS, Jeon CY, Lim JW, Cho EG, Park SM, Lee KS
- Journal
- CMAJ
- Year
- 2011
- Identifier
- PMID 21173070 DOI 10.1503/cmaj.092129 · PMC3042441
- 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
Are acid-suppressive drugs associated with pneumonia?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis of observational studies and RCTs
- Population
Adults in 31 studies
- Country
Multinational
- Period
to Aug 2009
- Sample size
31 studies (8 observational, 23 RCTs)
- Inclusion and exclusion criteria
see abstract
4. Methods and endpoints
- Exposure / intervention
PPI or H2RA
- Comparator
Non-use/placebo
- Endpoints
Community- and hospital-acquired pneumonia
- Statistical methods
Random-effects
5. Actual results
- Results
Observational: PPI adjusted OR 1.27 (1.11–1.46), I² 90.5%; H2RA OR 1.22 (1.09–1.36). RCTs (H2RA): hospital-acquired pneumonia RR 1.22 (1.01–1.48).
- Absolute risks
not reported in abstract
- Authors' conclusion
Acid suppressants may be associated with increased pneumonia risk; caution in at-risk patients.
6. Strengths
- Includes RCT data for H2RAs
7. Weaknesses
- Very high heterogeneity for PPIs
- PPI evidence observational only
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
PPI estimate from heterogeneous observational studies.
9. Assessment of the statistical interpretation
See results.
10. Relevance to the specific claim
11. Independent contrary findings
COMPASS RCT: no significant pneumonia difference.
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
Weak, heterogeneous association.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | mixed |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | partly correct but over-interpreted |
14. Open questions
15. Linked fact checks
- Long-term acid suppression causes hip fractures and pneumonia. – Studies supporting the claim
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?
Are acid-suppressive drugs associated with pneumonia?
- B. What did the authors find?
Observational: PPI adjusted OR 1.27 (1.11–1.46), I² 90.5%; H2RA OR 1.22 (1.09–1.36). RCTs (H2RA): hospital-acquired pneumonia RR 1.22 (1.01–1.48).
- C. What conclusions do the authors themselves draw?
Acid suppressants may be associated with increased pneumonia risk; caution in at-risk patients.
- D. What does the archive derive from it?
Supports pneumonia claim.
- E. Is this derivation scientifically justified?
Weakly; 'may be associated'.
- Adequacy of the interpretation (by the archive)
- partly correct but over-interpreted