Introduction
Acid suppression therapy is one of the most commonly prescribed
medications worldwide. These medications include proton pump inhibitors
(PPI) and Histamine-2 receptor antagonists (H2RA). They have been
game-changing for treating people with gastroesophageal reflux disease
(GORD) and peptic ulcers (1). Acidic stomach secretions with a pH level
of 3 or lower can kill the bacteria, and thus guard the intestines
against harm (2). Acid suppression therapy, while reducing stomach acid
can be beneficial to patients with acid-related diseases, may also leave
the gut vulnerable to some enteric infections (4, 5).
The coronavirus 2019 (COVID-19) is caused by severe acute respiratory
syndrome coronavirus 2 (SARS CoV-2). COVID-19 has been continuously
affecting populations worldwide, creating a global outbreak, since it
was initially reported in China in December 2019 (6). COVID-19 related
mortality rates vary widely among different populations, and risk
factors are still being identified. Some of the confirmed risk factors
include old age, chronic lung disease and smoking, cardiovascular
disease, chronic kidney disease, diabetes mellitus and obesity,
malignancy and chronic HIV infection (7). Use of various medications
have also been described to increase the risk of COVID-19; nevertheless,
these issues have not been ultimately confirmed.
COVID-19 can infect the GI system (8). Given the high expression of ACE2
receptor (the cellular receptor for SARS-CoV-2) in the intestinal
epithelium, it is highly plausible that the gut is a site of active
viral replication leading to GI involvement in COVID-19 (9, 10). This
raises the possibility of increased susceptibility to and severity of
COVID-19 infection among those using acid suppressant therapy.
Recently published observational studies highlight the various impacts
of the use of acid suppressant therapy in COVID-19 infection (11-14). We
review here the biological plausibility, the evidence and the
recommendations that can be made for acid suppressant use in the present
COVID-19 pandemic.