Influence of proton pump inhibitor use on clinical outcomes of patients with inflammatory bowel disease

Abstract

Objective Proton pump inhibitor (PPI) use has been associated with reduced diversity of the gut microbiome and may lead to worse clinical outcomes in inflammatory bowel disease (IBD). We aimed to evaluate whether PPI use affects clinical outcomes in a real-world setting. Design Healthcare claims data of adult IBD patients were obtained from the IBM MarketScan Database. Multivariable analysis and propensity score-matched analysis were performed to assess associations between PPI use and new biologic start, and IBD-related hospitalizations and surgeries. Results A total of 46,234 IBD patients were identified (6,488 (14%) and 39,746 (86%) patients with and without PPI, respectively). Patients on PPI were more likely to be older, female, and smokers and less likely to be on immunomodulators. Multivariable analyses demonstrated that PPI use was associated with new biologic start (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.04–1.18), and IBD-related admissions (OR 1.95, 95% CI 1.74–2.19) and surgeries (OR 1.46, 95% CI 1.26–1.71). Following propensity score matching, patients on PPI remained more likely to start a new biologic (23% vs 21%, p = 0.011), and have IBD-related admissions (8% vs 4%, p < 0.001) and surgeries (4% vs 2%, p < 0.001). Subgroup analyses stratified by age, smoking, and glucocorticoid use showed similar results. There was a dose-response relationship between the number of PPI prescriptions and the risk of new biologic use ( p < 0.001) and IBD-related admissions ( p < 0.001). Conclusion PPI use was associated with worse clinical outcomes in patients with IBD in the real-world setting. Further studies are warranted to validate these findings, but caution may be needed when prescribing a PPI to IBD patients. Study highlights WHAT IS KNOWN Proton pump inhibitors (PPIs) are one of the most prescribed therapies in the United States (US). Reduction of gastric acid secretion by PPI use increases the risk of imbalance in gut microbiota composition and may increase the risk of enteric infections. Recent studies have reported that the use of PPI was associated with development of inflammatory bowel disease (IBD) and reduced rates of remission in patients on infliximab therapy, which may be due to alterations of intestinal microbiota. WHAT IS NEW HERE In a large real-world US healthcare database study, IBD patients with PPI use were more likely to have a new biologic medication started, have an IBD-related surgery, and have an IBD-related hospitalization, which remained significant after adjusting for confounders by multivariable analysis, propensity-score matched analysis, and subgroup analysis. Appropriate clin...

Effects of proton pump inhibitors on inflammatory bowel disease: An updated review

“…More prospective studies are needed to confirm these findings. A recent real-world study conducted in the US evaluated the influence of PPI use on the clinical outcomes of IBD patients[ 79 ]. This US study identified 46234 IBD patients, of whom 6488 used PPIs, while the remaining (39746 patients) did not use them.…”

“…Compared to patients not on PPI therapy, those on concurrent PPI therapy were at a higher risk of developing undesirable clinical outcomes, such as new biologic initiation (OR = 1.11, 95%CI: 1.04-1.18), IBD-related admissions (OR = 1.95, 95%CI: 1.74-2.19), and surgeries (OR = 1.46, 95%CI: 1.26-1.71). Additionally, a dose-response relationship was noted between the number of PPI prescriptions and an increased risk of new biologic use and IBD-related admissions[ 79 ]. Hence, caution should be exercised when prescribing PPIs to IBD patients.…”

Multidisciplinary Consensus for Rationalizing the Use of Acid Suppressants in Children and Adults: CONFOR

“…In addition, a dose–response relationship indicated that high-dose PPI use was correlated with adverse outcomes. 53 …”

Research Progress of Cuttlebone in the Treatment of Chronic Atrophic Gastritis

“…The drug can reduce the secretion of gastric acid by gastric parietal cells by binding to H + -K + -ATPaseα. However, the combination of PPI and H + -K + -ATPase α is an irreversible process, so long-term use of the drug can cause a series of adverse reactions [31,32]. The application of cuttlebone in the treatment of CAG has the advantages of significant curative effect and small adverse reactions.…”