The impact of acid suppression medications and non-steroidal anti-inflammatory drugs on clinical and histologic features in celiac disease

Abstract

Introduction The prevalence of celiac disease (CD) in the US has increased in past decades, as has use of proton pump inhibitors (PPIs), histamine-2-receptor antagonists (H2RAs), aspirin (ASA) and nonsteroidal anti-inflammatory drugs (NSAIDs). We aimed to measure the association between medication use and distribution of villous flattening (VF) among newly diagnosed CD patients. Methods We performed a cross-sectional study of adult patients with newly-diagnosed CD at two institutions. We collected data on regular use of these medications, clinical presentation, CD serologic status, and distribution of VF. We compared current ASA/NSAID users to non-users, and current PPI/H2RA users to non-users, with regard to these clinical characteristics. Results Of 148 patients with newly-diagnosed CD, current users of ASA/NSAIDs were older than non-users (47 vs 39 years, p=0.003) and users of PPI/H2RAs were older than non-users (48 vs 39 years, p=0.004). PPI/H2RA users comprised 12% of seropositive patients, compared to 55% of seronegative patients (p<0.01). Patient gender and distribution of villous flattening in the bulb and distal duodenum did not differ by PPI/H2RA or ASA/NSAID use. Conclusions PPI/H2RA use was associated with seronegative CD. Given the effect of these medications on gastric milieu, the impact of these drugs on presentation and course of CD deserves further investigation.

Role of Duodenal Bulb Biopsy in Diagnosing Suspected Celiac Disease in Adult Patients

“…After assessing the full texts of the 46 journal articles based on above-mentioned inclusion and exclusion criteria, a total of 16 studies were included in the final analysis. 13,15,[26][27][28][29][30][31][32][33][34][35][36][37][38][39] Out of these, 12/16 were prospective studies. 13,15,26,27,29,[33][34][35][36][37][38] The schematic diagram of the screening and final selection of studies is shown in Supplementary Figure 1, Supplemental Digital Content 1, http:// links.lww.com/JCG/B4.…”

“…Of the 114 studies that were initially felt to be appropriate, 68 were conference abstracts, which were excluded from the final analysis. After assessing the full texts of the 46 journal articles based on above-mentioned inclusion and exclusion criteria, a total of 16 studies were included in the final analysis 13,15,26–39 . Out of these, 12/16 were prospective studies 13,15,26,27,29,33–38 .…”