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Editor's Correspondence
May 26, 2008

Acid Suppression Not the Only Culprit of Community-Acquired Pneumonia—Reply

Arch Intern Med. 2008;168(10):1119. doi:10.1001/archinte.168.10.1119

In reply

We are pleased that our study1 has generated interest, and we appreciate the opportunity to respond to the queries.

Kerman and Barkin have pointed out GERD and other risk factors for CAP. Gastroesophageal reflux disease itself might explain an excess in the incidence of CAP among proton pump inhibitor users.2 Reflux is associated with some airway symptoms, such as cough and uncontrolled asthma, but there is little evidence to support a strong association between reflux disease and CAP.3,4 Second, only a minority of proton pump inhibitor users in our setting had verified reflux.5 Finally, we also found an association among persons who took proton pump inhibitors for indications other than reflux (eg, peptic ulcer). Therefore, a strong confounding by reflux is unlikely.