Proton pump inhibitors use and risk of inflammatory bowel diseases: a meta-analysis of observational studies

Shastri, Sanjana Aditya; Kantamneni, Raveena; Rashid, Muhammed; Chandran, Vijay; Suhita, Ramadugula; Begum, Izwath; Nair, Sreekumaran; Thunga, Girish

doi:10.15386/mpr-2259

Cited by 6 publications

(7 citation statements)

References 31 publications

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“…However, the use of PPIs may cause dysbiosis of the microbiota. Several studies have indicated a link between the use of PPIs and the development of IBD[ 30 - 32 ]. An extensive analysis of the microbiota has revealed significant similarities in the changes observed in the intestinal microbiota of both IBD patients and PPI users, suggesting that the intestinal microbiota may play a major role in PPI-induced IBD[ 33 ].…”

Section: Mechanisms For Potential Effects Of Ppis On Ibdmentioning

confidence: 99%

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

Liang,

Meng,

Ding

et al. 2024

World J Gastroenterol

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Inflammatory bowel disease (IBD) is believed to be caused by various factors, including abnormalities in disease susceptibility genes, environmental factors, immune factors, and intestinal bacteria. Proton pump inhibitors (PPIs) are the primary drugs used to treat acid-related diseases. They are also commonly prescribed to patients with IBD. Recent studies have suggested a potential association between the use of certain medications, such as PPIs, and the occurrence and progression of IBD. In this review, we summarize the potential impact of PPIs on IBD and analyze the underlying mechanisms. Our findings may provide insights for conducting further investigations into the effects of PPIs on IBD and serve as an important reminder for physicians to exercise caution when prescribing PPIs to patients with IBD.

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Section: Mechanisms For Potential Effects Of Ppis On Ibdmentioning

confidence: 99%

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

Liang,

Meng,

Ding

et al. 2024

World J Gastroenterol

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“…Reducing gastric acid production with PPIs can affect the resistance of the gut microbiota to intestinal infections and even promote intestinal inflammation [25,26]. Indeed, the question arises whether the increased use of PPIs may contribute to the increasing incidence of IBD worldwide [27]. Several observational studies and meta-analyses have confirmed that there may be a possible relationship between IBD and PPI intake, so patients exposed to PPI are at significantly increased risk of IBD [28,29].…”

Section: Introductionmentioning

confidence: 99%

Co-Administration of Proton Pump Inhibitors May Negatively Affect the Outcome in Inflammatory Bowel Disease Treated with Vedolizumab

Szemes,

Farkas,

Sipos

et al. 2024

Biomedicines

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Concomitant medications may alter the effect of biological therapy in inflammatory bowel disease. The aim was to investigate the effect of proton pump inhibitors on remission rates in patients with inflammatory bowel disease treated with the gut-selective vedolizumab. Patients from the Hungarian nationwide, multicenter vedolizumab cohort were selected for post hoc analysis. Primary outcomes were the assessment of clinical response and endoscopic and clinical remission at weeks 14 and 54. Secondary outcomes were the evaluation of the combined effect of concomitant steroid therapy and other factors, such as smoking, on remission. A total of 108 patients were identified with proton pump inhibitor data from 240 patients in the original cohort. Patients on steroids without proton pump inhibitors were more likely to have a clinical response at week 14 than patients on concomitant PPI (95% vs. 67%, p = 0.005). Non-smokers with IBD treated with VDZ were more likely to develop a clinical response at week 14 than smokers, particularly those not receiving PPI compared with patients on co-administered PPI therapy (81% vs. 53%, p = 0.041, and 92% vs. 74%, p = 0.029, respectively). We found that the use of PPIs in patients treated with VDZ may impair the achievement of response in certain subgroups. Unnecessary PPI prescriptions should be avoided.

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“…Proton pump inhibitors (PPIs) are commonly prescribed medications widely used for acid suppression in different gastrointestinal diseases [1][2][3][4][5]. In fact, PPIs constitute the first-line therapy for gastroesophageal reflux disease (GERD), esophagitis, Helicobacter pylori infection, Zollinger-Ellison Disease, and peptic ulcer disease (PUD) [1][2][3][4][5][6][7]. Ever since its introduction to the United States (US) market, the number of PPI users has been increasing annually [3,5,6,8].…”

Section: Introductionmentioning

confidence: 99%

“…In fact, PPIs constitute the first-line therapy for gastroesophageal reflux disease (GERD), esophagitis, Helicobacter pylori infection, Zollinger-Ellison Disease, and peptic ulcer disease (PUD) [1][2][3][4][5][6][7]. Ever since its introduction to the United States (US) market, the number of PPI users has been increasing annually [3,5,6,8]. In 2016 alone, more than 150 million PPIs were prescribed in the US, not counting over-the-counter (OTC) medications [9].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Risk Factors Associated With Inflammatory Bowel Disease in Patients Using Proton-Pump Inhibitors: A Population-Based Study

Onwuzo¹,

Boustany²,

Zeid³

et al. 2023

Cureus

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Background and aimProton pump inhibitor (PPI) is a heavily prescribed medication in the United States that is used to treat several gastrointestinal disorders. Although it has been considered to be safe compared to other medications, multiple gastrointestinal side effects have been reported. These effects of PPIs might stem from the progressive alteration of the intestinal microbiome. Patients with inflammatory bowel disease (IBD) using PPI are also seen to be less likely to achieve remission. However, in the current literature, there is very little evidence of the risk of developing IBD in patients who have been using PPIs. Therefore, our aim was to perform a cross-sectional population-based study with in-depth analysis to assess the prevalence and risk factors of IBD amongst PPI users in the United States. MethodologyA validated multicenter and research platform database of more than 360 hospitals from 26 different healthcare systems across the United States was utilized to construct this study. A cohort of patients with a diagnosis of ulcerative colitis (UC) and Crohn's disease (CD) between 1999-2022 was identified using the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT). Patients aged 18 to 65 years were included. We excluded any individual who had a diagnosis of chronic liver disease, autoimmune disease (excluding IBD), or cancer. The risk of IBD was calculated using a multivariate regression analysis to account for potential confounders including non-steroidal anti-inflammatory drugs (NSAIDs) use, smoking, patients who have had a diagnosis of alcoholism, gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), and metabolic syndrome. A two-sided P-value <0.05 was considered statistically significant, and all statistical analyses were performed using R version 4.0.2 (R Foundation for Statistical Computing, Vienna, Austria, 2008). ResultsA total of 79,984,328 individuals were screened in the database and 45,586,150 patients were selected in the final analysis after accounting for inclusion and exclusion criteria. Using multivariate regression analysis, the risk of developing UC and CD was calculated. The odds of having UC amongst patients on PPI was 2.02 (95%CI 1.98-2.06), P-value <0.001. Similarly, the odds of having CD were high amongst PPI users (OR 2.79, 95%CI 2.75-2.84), P-value <0.001 ConclusionOur study demonstrates that patients on PPIs are frequently found to have UC and CD even when adjusting for common risk factors. Hence, we urge clinicians to be aware of this association in order to limit unnecessary prescriptions of PPIs, especially for patients who are at risk for autoimmune diseases.

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Proton pump inhibitors use and risk of inflammatory bowel diseases: a meta-analysis of observational studies

Cited by 6 publications

References 31 publications

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

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

Co-Administration of Proton Pump Inhibitors May Negatively Affect the Outcome in Inflammatory Bowel Disease Treated with Vedolizumab

Prevalence and Risk Factors Associated With Inflammatory Bowel Disease in Patients Using Proton-Pump Inhibitors: A Population-Based Study

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