Clostridium difficile-Associated Diarrhea and PPI Therapy
Clostridium difficile-Associated Diarrhea and PPI Therapy
Two reviewers (SJ and ID) independently and in duplicate conducted a systematic literature search on MEDLINE and PubMed databases from 1990 through December 2010. Search terms included "proton pump inhibitor," "acid suppressive therapy," individual PPI generic names, combined with "Clostridium difficile infection", "diarrhea", "colitis" "gastrointestinal infection", and "pseudomembranous colitis." The title and abstract of eligible studies were then reviewed to exclude any that were irrelevant to the research question. British spelling terms were also searched to increase search yield. This process included electronic searching of supplementary abstracts published in various gastroenterology and other journals. The titles and abstracts of studies identified in the search were reviewed to exclude any that were irrelevant to the research question. The full text of the remaining articles was read and their bibliographic lists reviewed for additional publications on the subject. No language restriction was used in the search filter. We did not include data presented only as abstracts at conferences.
Study references and citations were collected in Endnote software application version 8.0 (Thomson Reuters, New York, NY). A data collection form was designed in Microsoft Access 2007 (Microsoft, Redmond, WA). Abstracted data from each study included: first author's last name, year of publication, country of the population studied, study design, age range, number of participants, duration of PPI use, effect estimates (odds ratio (ORs) or risk ratios (RRs), and 95% confidence intervals (CIs) of PPI exposure (Table 1). The disease exposure was defined as acute diarrhea with toxin confirmation. In studies reporting several effect estimates, we extracted that with the greatest degree of control for potential confounders. Inter-extractor discrepancies were resolved by referring to the original article.
Methods
Search Strategy
Two reviewers (SJ and ID) independently and in duplicate conducted a systematic literature search on MEDLINE and PubMed databases from 1990 through December 2010. Search terms included "proton pump inhibitor," "acid suppressive therapy," individual PPI generic names, combined with "Clostridium difficile infection", "diarrhea", "colitis" "gastrointestinal infection", and "pseudomembranous colitis." The title and abstract of eligible studies were then reviewed to exclude any that were irrelevant to the research question. British spelling terms were also searched to increase search yield. This process included electronic searching of supplementary abstracts published in various gastroenterology and other journals. The titles and abstracts of studies identified in the search were reviewed to exclude any that were irrelevant to the research question. The full text of the remaining articles was read and their bibliographic lists reviewed for additional publications on the subject. No language restriction was used in the search filter. We did not include data presented only as abstracts at conferences.
Study references and citations were collected in Endnote software application version 8.0 (Thomson Reuters, New York, NY). A data collection form was designed in Microsoft Access 2007 (Microsoft, Redmond, WA). Abstracted data from each study included: first author's last name, year of publication, country of the population studied, study design, age range, number of participants, duration of PPI use, effect estimates (odds ratio (ORs) or risk ratios (RRs), and 95% confidence intervals (CIs) of PPI exposure (Table 1). The disease exposure was defined as acute diarrhea with toxin confirmation. In studies reporting several effect estimates, we extracted that with the greatest degree of control for potential confounders. Inter-extractor discrepancies were resolved by referring to the original article.
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