611. Acid Suppression with Histamine[H2] Blockers and Proton Pump Inhibitors[PPIs] is not Associated with an Increased Risk of Traveler’s Diarrhea [TD]
Session: Poster Abstract Session: Oh One World: Infections from Near and Far
Thursday, October 27, 2016
Room: Poster Hall
  • HUTTER AS IDSA poster.pdf (957.7 kB)
  • Background:

    Gastric acid plays an important role in eliminating bacterial pathogens; agents that suppress gastric acid production such as proton pump inhibitors have been associated with infectious gastroenteritis. Achlorhydria is associated with TD, and it is speculated that those on PPIs and H2blockers are at an increased risk, however, studies specifically examining this question are lacking. This study aims to bridge this gap.


    The TravMil study is a cohort study that prospectively assesses infectious disease risk and effectiveness of prevention and treatment strategies among Department of Defense beneficiaries. Participants receive pre- and post-travel surveys (assessing TD symptoms and use of PPI and H2blockers use). TD was defined as 3 or more loose stools within 24 hours or 2 loose stools plus an associated symptom within 24 hours. A multivariate Poisson regression analysis was performed to examine the influence of PPI and H2 blocker use and TD. 


    Of the 2,531 eligible subjects, 524 (21%) met criteria for TD. 395 (16%) subjects reported H2 or PPI blocker use. Rate of TD were similar among users 94 (24%) and non-users 430 (20%). As shown below, in a multivariate analysis, the only risk factors associated with TD were food source (street vendor) and consuming raw foods. Use of PPIs and H2 blockers were not associated with TD even in the univariate analysis [RR: 1.18 (0.97-1.44)]. Regional travel and military purpose were not significant in the univariate analysis.

    Risk Factors for TD










    Antibiotics Use





    Food Source


    Street Vendor



    Drink untreated water



    Using ice



    Consumption of raw foods




    In our cohort self-reported use of PPIs/H2 blockers were not associated with TD. We confirmed some previously identified risk factors for TD. These results suggest that no additional counseling over the standard regimen may be needed for patients on a PPI or H2 blocker, but our results need confirmation in larger cohorts.

    Jack Hutter Jr., MD, MPHTM1, Tahaniyat Lalani, MD2,3,4, Heather Yun, MD, FIDSA5, David Tribble, MD, DrPH, FIDSA2, Anjali Kunz, MD6, Mary Fairchok, MD2, Elizabeth Schnaubelt, MD7, Jamie Fraser, MPH2,4, Indrani Mitra, MS2,4, Timothy Burgess, MD2, Mark S. Riddle, MD, DrPH8, Mark Johnson, MD, MTM&H9 and Anuradha Ganesan, MD, MPH1,2,4, (1)Infectious Disease, Walter Reed National Military Medical Center, Bethesda, MD, (2)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (3)Division of Infectious Diseases, Naval Medical Center Portsmouth, Portsmouth, Portsmouth, VA, (4)Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, (5)San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, (6)Madigan Army Medical Center, Tacoma, WA, (7)Landstuhl Regional Medical Center, Landstuhl, Germany, (8)Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, (9)Naval Health Research Center, Naval Medical Center San Diego, San Diego, CA


    J. Hutter Jr., None

    T. Lalani, None

    H. Yun, None

    D. Tribble, None

    A. Kunz, None

    M. Fairchok, None

    E. Schnaubelt, None

    J. Fraser, None

    I. Mitra, None

    T. Burgess, None

    M. S. Riddle, None

    M. Johnson, None

    A. Ganesan, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.