The Use of PPIs and Risk of COVID-19: Is there a Connection?

There is evidence of an independent, dose-response relationship between the use of anti-secretory medications and COVID-19 positivity; individuals taking PPIs twice daily have higher odds for reporting a positive test when compared to those using PPIs up to once daily, and those taking the less potent H2RAs are not at increased risk. This is the finding of an observational study published in The American Journal of Gastroenterology, July 7, 2020. The online survey enrolled 53,130 adults.

Previous study has shown that pH ≤3 impairs the infectivity of severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1). Based on the findings of the current study, this appears to be the case for SARS-CoV-2.

According to the study authors, because SARS-CoV-2 uses the angiotensin converting enzyme 2 receptor to invade and rapidly replicate in enterocytes, an increase in gastric pH >3 due to the use of PPIs could allow it to more easily enter the gastrointestinal tract, which would lead to enteritis, colitis and systemic spread to other organs, including the lungs.

Information Sheet and FAQs About Proton Pump Inhibitors (PPIs) and Risk of COVID-19

Members of the American College of Gastroenterology (ACG) leadership team partnered with the study authors to prepare a brief overview of the research, discuss its findings, and address potential implications for clinical care.

The group addressed the following questions:

1. What are the main results of the study?
2. Do patients need to stop their PPIs right now because of this study?
3. How might you use the results of this study to advise patients taking PPIs?
4. Why was this study performed?
5. What are the limitations of the study?

Click here for details: https://webfiles.gi.org/

Sources:

1. Almario CV, Chey WD, Spiegel BMR. Increased risk of COVID-19 among users of proton pump inhibitors. Am J Gastroenterol 2020. Available online: https://journals.lww.com/ajg/Documents/AJG-20-1811_R1(PUBLISH%20AS%20WEBPART).pdf
2. The American Journal of Gastroenterology. Information Sheet and FAQs About Proton Pump Inhibitors (PPIs) and Risk of COVID-19. Available online: https://webfiles.gi.org/links/media/ACG_Almario_et_al_Info_Sheet_and_FAQs_About_PPIs_COVID19_07072020_FINAL.pdf