Acid indigestion? A PPI = greater COVID19 chance

COVID-19 Alert: Medical researchers from Cedars-Sinai Medical Center, Michigan Medicine and UCLA Fielding School of Public Health have found an association between proton pump inhibitors (PPIs) and risk of COVID-19 in an observational study of more than 53,000 Americans.It was found that PPIs usage was linked with a higher risk for COVID-19.

This places the usage of PPIs for heartburn and gastric reflux such as Prilosec, Zegerid, Prevacid, Protonix, Aciphex, Nexium, Dexilant, Miracid as a risk factor alongside the long range of risk factors including gender, age, having underlying chronic diseases such as diabetes, high blood pressure, cardiovascular issues, blood type etc for the COVID-19 disease.
 
The preliminary preprint version of the research findings are published in the American Journal of Gastroenterology as it is almost finished being peer-reviewed. https://journals.lww.com/ajg/Documents/AJG-20-1811_R1(PUBLISH%20AS%20WEBPART).pdf  (Almario CV, Chey WD, Spiegel BMR. Increased risk of COVID-19 among users of proton pump inhibitors. Am J Gastroenterol 2020)
 
Research findings from an online survey suggest that using heartburn medications known as proton pump inhibitors (PPIs) once or twice daily significantly increases the odds of a positive test for COVID-19 compared to those who do not take PPIs.

Medical researchers Dr Christopher V. Almario, MD, MSHPM and Professor Dr Brennan M. R. Spiegel, MD, MSHS, FACG of Cedars-Sinai in Los Angeles along with Dr William D. Chey, MD, FACG of the University of Michigan conducted a large population-based, online survey to evaluate whether use of PPIs increases risk of COVID-19.
 
Dr Almario told Thailand Medical News via  a phone interview, "We developed this hypothesis at the beginning of the COVID-19 pandemic when we started to see a high incidence of GI symptoms and learned that the virus sheds into saliva, and thus can be swallowed into the stomach. We have now tested the hypothesis in a rigorous study of more than 50,000 Americans and found it to bear out, albeit in an observational study."

The researchers said that PPIs increase the risk for enteric infections which is likely related to PPI-induced hypochlorhydria, or low levels of gastric acid.
 
Dr Spiegel added, "Although the impact of acid suppression on SARS-CoV-2 coronavirus  is unknown thus far, prior data revealed that pH ≤3 impairs the infectivity of the similar SARS-CoV-1. Thus, we aimed to determine whether use of PPIs increases the odds for acquiring COVID-19 among community-dwelling Americans."

From the study 53,130 participants, 3,386 (6.4%) reported a positive COVID-19 test. In regression analysis, individuals using PPIs up to once daily (OR 2.15; 95% CI, 1.90–2.44) or twice daily (OR 3.67; 95% CI, 2.93–4.60) had significantly increased odds for reporting a positive COVID-19 test when compared to those not taking PPIs. Individuals taking histamine-2 receptor antagonists (H2RAs) were not at elevated risk.
 
Dr Spiegel, Co-Editor-in Chief of The American Journal of Gastroenterology further commented, "There is a reason we have acid in our stomach, namely, to kill pathogens before they enter the digestive tract. Coronaviruses are easily destroyed at a gastric pH of less than 3, but survive in a more neutral pH, including the range created by drugs like omeprazole and esomeprazole."
 
He further added, "We found a strong, independent effect of using PPIs on risk of COVID-19, including a dose-response relationship with nearly a four-fold increased risk for twice daily dosing. But we found no relationship with the less powerful H2RAs, such as famotidine or cimetidine.”
 
Dr Spiegel added, "Previous research has already demonstrated that PPIs slightly increase the risk of enteric infections, but the strong link found here speaks to COVID-19 pathogenesis through the GI tract, where the expression of the receptors the virus uses to enter the body, known as ACE-2 receptors, is roughly 100-fold higher than in any other part of the body, including the lungs."
 
Although these data arise from:- a large sample, -demonstrate a large effect size,- reveal a dose-response relationship, -are controlled for confounders, and -are different from a control group using H2RAs,  all strengthening the results, the investigators note that further studies examining the association between PPIs and COVID-19 are needed.

Dr Brian E. Lacy, MD, PhD, FACG, Co-Editor-in-Chief of The American Journal of Gastroenterology commented, "The results of this large survey study, from an experienced team of clinicians and researchers, are intriguing and add novel, clinically relevant information to the rapidly evolving field of COVID-19 during this devastating pandemic. Prior research studies have shown that PPIs slightly increase the risk of an infection developing in the gastrointestinal tract. We now recognize that receptors for COVID-19, (ACE-2) are found throughout the gastrointestinal tract, which supports the biologic plausibility that PPI use could be associated with an increased risk for COIVD-19. However, as the authors carefully point out in their thoughtful analysis, this is not a randomized, placebo-controlled study, but rather a study demonstrating an association, and thus studies from other groups should be analyzed to confirm these novel findings."
 https://www.thailandmedical.news/news/breaking-news-covid-19-alert-research-led-by-cedars-sinai-indicates-that-proton-pump-inhibitors-ppis-use-is-linked-to-increased-risk-of-covid-19