{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T17:35:49Z","timestamp":1793036149377,"version":"4.5.0"},"reference-count":54,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","license":[{"start":{"date-parts":[[2012,7,1]],"date-time":"2012-07-01T00:00:00Z","timestamp":1341100800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,7]]},"DOI":"10.1038\/ajg.2012.179","type":"journal-article","created":{"date-parts":[[2012,6,19]],"date-time":"2012-06-19T10:42:12Z","timestamp":1340102532000},"page":"1001-1010","source":"Crossref","is-referenced-by-count":443,"title":["Clostridium difficile -Associated Diarrhea and Proton Pump Inhibitor Therapy: A Meta-Analysis"],"prefix":"10.14309","volume":"107","author":[{"given":"Sailajah","family":"Janarthanan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo","family":"Ditah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas G","family":"Adler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murray N","family":"Ehrinpreis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-10-20210210","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1086\/518874","article-title":"The challenges posed by reemerging Clostridium difficile infection.","volume":"45","author":"Blossom","year":"2007","journal-title":"Clin Infect Dis"},{"key":"R2-10-20210210","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/j.cgh.2007.05.030","article-title":"Playing host to the difficult Clostridium.","volume":"5","author":"Kelly","year":"2007","journal-title":"Clin Gastroenterol Hepatol"},{"key":"R3-10-20210210","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1086\/338260","article-title":"Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile.","volume":"34","author":"Kyne","year":"2002","journal-title":"Clin Infect Dis"},{"key":"R4-10-20210210","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1503\/cmaj.1031189","article-title":"Clostridium difficile-associated diarrhea in adults.","volume":"171","author":"Poutanen","year":"2004","journal-title":"CMAJ"},{"key":"R5-10-20210210","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1093\/clinids\/17.1.109","article-title":"Clostridium difficile infection associated with antineoplastic chemotherapy: a review.","volume":"17","author":"Anand","year":"1993","journal-title":"Clin Infect Dis"},{"key":"R6-10-20210210","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0195-6701(98)90019-6","article-title":"Risk factors for Clostridium difficile infection.","volume":"40","author":"Bignardi","year":"1998","journal-title":"J Hosp Infect"},{"key":"R7-10-20210210","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1038\/ncpgasthep1029","article-title":"Update on the changing epidemiology of Clostridium difficile-associated disease.","volume":"5","author":"McFarland","year":"2008","journal-title":"Nat Clin Pract Gastroenterol Hepatol"},{"key":"R8-10-20210210","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1086\/588756","article-title":"Rising economic impact of clostridium difficile-associated disease in adult hospitalized patient population.","volume":"29","author":"Song","year":"2008","journal-title":"Infect Control Hosp Epidemiol"},{"key":"R9-10-20210210","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1017\/S0195941700026072","article-title":"The emerging infectious challenge of clostridium difficile-associated disease in Massachusetts hospitals: clinical and economic consequences.","volume":"28","author":"OBrien","year":"2007","journal-title":"Infect Control Hosp Epidemiol"},{"key":"R10-10-20210210","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1001\/archinternmed.2010.73","article-title":"Proton pump inhibitors and risk for recurrent Clostridium difficile infection.","volume":"170","author":"Linsky","year":"2010","journal-title":"Arch Intern Med"},{"key":"R11-10-20210210","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/S0016-5085(82)80345-4","article-title":"Possible foodborne transmission in a case of pseudomembranous colitis due to Clostridium difficile: influence of gastrointestinal secretions on Clostridium difficile infection.","volume":"83","author":"Gurian","year":"1982","journal-title":"Gastroenterology"},{"key":"R12-10-20210210","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1111\/j.1348-0421.2007.tb04016.x","article-title":"Comparative role of antibiotic and proton pump inhibitor in experimental Clostridium difficile infection in mice.","volume":"51","author":"Kaur","year":"2007","journal-title":"Microbiol Immunol"},{"key":"R13-10-20210210","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1111\/j.1572-0241.2007.01275.x","article-title":"Systematic review of the risk of enteric infection in patients taking acid suppression.","volume":"102","author":"Leonard","year":"2007","journal-title":"Am J Gastroenterol"},{"key":"R14-10-20210210","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/oxfordjournals.epirev.a036298","article-title":"Quantitative methods in the review of epidemiologic literature.","volume":"9","author":"Greenland","year":"1987","journal-title":"Epidemiol Rev"},{"key":"R15-10-20210210","doi-asserted-by":"crossref","first-page":"1690","DOI":"10.1001\/jama.280.19.1690","article-title":"Whats the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes.","volume":"280","author":"Zhang","year":"1998","journal-title":"JAMA"},{"key":"R16-10-20210210","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials.","volume":"7","author":"DerSimonian","year":"1986","journal-title":"Controlled Clin Trials"},{"key":"R17-10-20210210","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0889-8529(05)70232-2","article-title":"Meta-analysis and endocrinology.","volume":"26","author":"Petitti","year":"1997","journal-title":"Endocrinol Metabol Clin North America"},{"key":"R18-10-20210210","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.2307\/2533446","article-title":"Operating characteristics of a rank correlation test for publication bias.","volume":"50","author":"Begg","year":"1994","journal-title":"Biometrics"},{"key":"R19-10-20210210","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test.","volume":"315","author":"Egger","year":"1997","journal-title":"Br Med J"},{"key":"R20-10-20210210","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/j.0006-341X.2000.00455.x","article-title":"Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.","volume":"56","author":"Duval","year":"2000","journal-title":"Biometrics"},{"key":"R21-10-20210210","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1002\/sim.1188","article-title":"Issues in the selection of a summary statistic for meta-analysis of clinical trials with binary outcomes.","volume":"21","author":"Deeks","year":"2002","journal-title":"Stat Med"},{"key":"R22-10-20210210","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses.","volume":"327","author":"Higgins","year":"2003","journal-title":"Br Med J"},{"key":"R23-10-20210210","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","article-title":"Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.","volume":"283","author":"Stroup","year":"2000","journal-title":"JAMA"},{"key":"R24-10-20210210","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1503\/cmaj.1040876","article-title":"Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies.","volume":"171","author":"Dial","year":"2004","journal-title":"CMAJ"},{"key":"R25-10-20210210","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1111\/j.1365-2036.2008.03924.x","article-title":"Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low-endemicity, non-outbreak hospital setting.","volume":"29","author":"Dalton","year":"2009","journal-title":"Aliment Pharmacol Ther"},{"key":"R26-10-20210210","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1086\/523582","article-title":"Clostridium difficile-associated disease in a setting of endemicity: identification of novel risk factors.","volume":"45","author":"Dubberke","year":"2007","journal-title":"Clin Infect Dis"},{"key":"R27-10-20210210","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1086\/430315","article-title":"Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada.","volume":"40","author":"Pepin","year":"2005","journal-title":"Clin Infect Dis"},{"key":"R28-10-20210210","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1111\/j.1365-2036.2006.03015.x","article-title":"Proton pump inhibitor therapy is a risk factor for Clostridium difficile-associated diarrhoea.","volume":"24","author":"Yearsley","year":"2006","journal-title":"Aliment Pharmacol Ther"},{"key":"R29-10-20210210","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1111\/j.1365-2036.2009.04229.x","article-title":"Proton pump inhibitors as a risk factor for paediatric Clostridium difficile infection.","volume":"31","author":"Turco","year":"2010","journal-title":"Aliment Pharmacol Ther"},{"key":"R30-10-20210210","doi-asserted-by":"crossref","first-page":"3573","DOI":"10.3748\/wjg.v16.i28.3573","article-title":"Proton pump inhibitors as a risk factor for recurrence of Clostridium-difficile-associated diarrhea.","volume":"16","author":"Kim","year":"2010","journal-title":"World J Gastroenterol"},{"key":"R31-10-20210210","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/archinternmed.2010.89","article-title":"Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection.","volume":"170","author":"Howell","year":"2010","journal-title":"Arch Intern Med"},{"key":"R32-10-20210210","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1038\/ajg.2009.615","article-title":"Clostridium difficile is associated with poor outcomes in patients with cirrhosis: a national and tertiary center perspective.","volume":"105","author":"Bajaj","year":"2010","journal-title":"Am J Gastroenterol"},{"key":"R33-10-20210210","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/j.1462-2920.2008.01790.x","article-title":"Clostridium difficile PCR ribotype 078 toxinotype V found in diarrhoeal pigs identical to isolates from affected humans.","volume":"11","author":"Debast","year":"2009","journal-title":"Environ Microbiol"},{"key":"R34-10-20210210","doi-asserted-by":"crossref","first-page":"2308","DOI":"10.1111\/j.1572-0241.2008.01975.x","article-title":"Gastric acid suppression by proton pump inhibitors as a risk factor for Clostridium difficile-associated diarrhea in hospitalized patients.","volume":"103","author":"Aseeri","year":"2008","journal-title":"Am J Gastroenterol"},{"key":"R35-10-20210210","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1086\/524320","article-title":"Case-control study of antibiotic use and subsequent Clostridium difficile-associated diarrhea in hospitalized patients.","volume":"29","author":"Baxter","year":"2008","journal-title":"Infect Control Hosp Epidemiol"},{"key":"R36-10-20210210","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.2146\/ajhp060629","article-title":"Association of proton-pump inhibitors with outcomes in Clostridium difficile colitis.","volume":"64","author":"Cadle","year":"2007","journal-title":"Am J Health Sys Pharm"},{"key":"R37-10-20210210","first-page":"241","article-title":"Clostridium difficile infection in an urban medical center: five-year analysis of infection rates among adult admissions and association with the use of proton pump inhibitors.","volume":"37","author":"Jayatilaka","year":"2007","journal-title":"Ann Clin Lab Sci"},{"key":"R38-10-20210210","first-page":"500","article-title":"Increasing incidence of Clostridium difficile-associated diarrhea in African-American and Hispanic patients: association with the use of proton pump inhibitor therapy.","volume":"99","author":"Akhtar","year":"2007","journal-title":"J Natl Med Assoc"},{"key":"R39-10-20210210","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1503\/cmaj.060284","article-title":"Proton pump inhibitor use and risk of community-acquired Clostridium difficile-associated disease defined by prescription for oral vancomycin therapy.","volume":"175","author":"Dial","year":"2006","journal-title":"CMAJ"},{"key":"R40-10-20210210","doi-asserted-by":"crossref","first-page":"2989","DOI":"10.1001\/jama.294.23.2989","article-title":"Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease.","volume":"294","author":"Dial","year":"2005","journal-title":"JAMA"},{"key":"R41-10-20210210","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/S0195-6701(03)00088-4","article-title":"Proton pump inhibitors as a risk factor for Clostridium difficile diarrhoea.","volume":"54","author":"Cunningham","year":"2003","journal-title":"J Hosp Infect"},{"key":"R42-10-20210210","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1093\/qjmed\/93.3.175","article-title":"Gastric acid suppression does not promote clostridial diarrhoea in the elderly.","volume":"93","author":"Shah","year":"2000","journal-title":"QJM"},{"key":"R43-10-20210210","doi-asserted-by":"crossref","first-page":"2518","DOI":"10.1001\/archinte.166.22.2518","article-title":"A hospital outbreak of diarrhea due to an emerging epidemic strain of Clostridium difficile.","volume":"166","author":"Kazakova","year":"2006","journal-title":"Arch Intern Med"},{"key":"R44-10-20210210","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1086\/508453","article-title":"Proton pump inhibitors and hospitalization for Clostridium difficile-associated disease: a population-based study.","volume":"43","author":"Lowe","year":"2006","journal-title":"Clin Infect Dis"},{"key":"R45-10-20210210","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1086\/521664","article-title":"Risk of Clostridium difficile-associated disease among patients receiving proton-pump inhibitors in a Quebec medical intensive care unit.","volume":"28","author":"Beaulieu","year":"2007","journal-title":"Infect Control Hosp Epidemiol"},{"key":"R46-10-20210210","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.3748\/wjg.v16.i19.2323","article-title":"Safety of the long-term use of proton pump inhibitors.","volume":"16","author":"Thomson","year":"2010","journal-title":"World J Gastroenterol"},{"key":"R47-10-20210210","doi-asserted-by":"crossref","first-page":"2883","DOI":"10.1128\/AAC.01443-06","article-title":"Vegetative Clostridium difficile survives in room air on moist surfaces and in gastric contents with reduced acidity: a potential mechanism to explain the association between proton pump inhibitors and C. difficile-associated diarrhea?","volume":"51","author":"Jump","year":"2007","journal-title":"Antimicrob Agents Chemother"},{"key":"R48-10-20210210","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/00000441-200402000-00007","article-title":"Coinfection with Giardia lamblia and Clostridium difficile after use of ranitidine.","volume":"327","author":"Khatami","year":"2004","journal-title":"Am J Med Sci"},{"key":"R49-10-20210210","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1093\/infdis\/151.2.355","article-title":"Population dynamics of ingested Clostridium difficile in the gastrointestinal tract of the Syrian hamster.","volume":"151","author":"Wilson","year":"1985","journal-title":"J Infect Dis"},{"key":"R50-10-20210210","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1046\/j.1365-2036.1996.d01-506.x","article-title":"Altered bowel function and duodenal bacterial overgrowth in patients treated with omeprazole.","volume":"10","author":"Lewis","year":"1996","journal-title":"Aliment Pharmacol Ther"},{"key":"R51-10-20210210","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1365-2036.2006.02707.x","article-title":"Review article: proton pump inhibitors and bacterial overgrowth.","volume":"23","author":"Williams","year":"2006","journal-title":"Aliment Pharmacol Ther"},{"key":"R52-10-20210210","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/S1091-255X(00)80032-3","article-title":"Suppression of gastric acid secretion in patients with gastroesophageal reflux disease results in gastric bacterial overgrowth and deconjugation of bile acids.","volume":"4","author":"Theisen","year":"2000","journal-title":"J Gastrointest Surg"},{"key":"R53-10-20210210","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.tim.2010.10.004","article-title":"Germination of spores of Bacillales and Clostridiales species: mechanisms and proteins involved.","volume":"19","author":"Paredes-Sabja","year":"2011","journal-title":"Trends Microbiol"},{"key":"R54-10-20210210","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/S1542-3565(04)00717-7","article-title":"PPI use in the OTC era: who to treat, with what, and for how long?","volume":"3","author":"Inadomi","year":"2005","journal-title":"Clin Gastroenterol Hepatol"}],"container-title":["American Journal of Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.nature.com\/articles\/ajg2012179.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.nature.com\/articles\/ajg2012179","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.nature.com\/articles\/ajg2012179.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/www.ovid.com\/00000434-201207000-00010","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T13:38:35Z","timestamp":1786541915000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00000434-201207000-00010"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,7]]},"references-count":54,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2012]]}},"URL":"https:\/\/doi.org\/10.1038\/ajg.2012.179","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.717950608.793459150","asserted-by":"object"},{"id-type":"doi","id":"10.3410\/f.717950608.793455916","asserted-by":"object"}]},"ISSN":["0002-9270"],"issn-type":[{"value":"0002-9270","type":"print"}],"subject":[],"published":{"date-parts":[[2012,7]]}}}