Open Access Research article

Acid suppressive agents and risk of Mycobacterium Tuberculosis: case–control study

Wen-Hung Hsu12, Chao-Hung Kuo12, Sophie SW Wang1, Chien-Yu Lu12, Chung-Jung Liu1, Seng-Kee Chuah3, Fu-Chen Kuo4, Yen-Hsu Chen5, Yaw-Bin Huang6, Ming-Feng Hou7, Deng-Chyang Wu128 and Huang-Ming Hu12*

Author Affiliations

1 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City 807, Taiwan

2 Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807, Taiwan

3 Division of Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan

4 School of Medicine, College of Medicine, E-Da Hospital, I-Shou University, Kaohsiung City 824, Taiwan

5 Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City 807, Taiwan

6 Graduate Institutes of Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan

7 Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung City 807, Taiwan

8 Division of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan

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BMC Gastroenterology 2014, 14:91  doi:10.1186/1471-230X-14-91

Published: 13 May 2014



The acid-suppressive agents have been linked with an increased risk of infectious disease. The relationship between these drugs and Mycobacterium Tuberculosis (TB) was not been reported.


We conducted a case–control study using data from National Health Insurance research database of Taiwan. From 1996 till 2008, and 6541 cases were defined as TB infection/activation (ICD-9 coding plus prescription two of four first-line anti-TB regimen for at least one month). Control subjects who were matched to the TB cases by age and sex were selected with 10:1 ratio. Medical records including acid-suppressive agent prescription and comorbidity, and socioeconomic status were analyzed.


TB infection/activation was more frequent to comorbidity with chronic diseases, alcohol abuse, malignancy, immune deficient/suppression status and acid-related disease (peptic ulcer, reflux esophagitis). Among the TB cases, there was higher exposure record to acid-suppressive agents within 3 months before TB index date (OR 2.43(2.06-2.88) and 1.90 (1.68-2.14) for proton pump inhibitor (PPI) and histamine 2 receptor antagonist (H2RA) respectively). After adjusting confounding factors, PPIs prescription 3 months before TB index date had an association of TB infection/activation (adjusted OR 1.63(1.61-1.63)). Similar result was found in H2RA user (adjusted OR 1.51(1.50-1.52)). The association of acid-suppressive agents in TB infection/activation was fade gradually when the drug prescription period extended.


Recent prescription of acid-suppressive agent seems to associate the TB infection/activation. In the society where TB was prevalent, evaluation of pulmonary TB before prescription of PPI or H2RA is warranted.

Proton pump inhibitor; Histamine2-receptor antagonist; Mycobacterium Tuberculosis; National health insurance database; Taiwan