Proton Pump Inhibitor Use is Associated with Worse Clinical Outcomes in Patients with Inflammatory Bowel Disease
Background:
Proton pump inhibitor (PPI) use is associated with reduced diversity of the gut microbiome and may increase the risk of enteric infections. However, there is limited data on the effect of PPI use on the clinical outcomes in patients with inflammatory bowel disease (IBD). We aimed to investigate the influence of PPI use on IBD clinical outcomes using real-world evidence.
Methods:
We conducted a retrospective cohort study using the TriNetX database, which provides access to real-time deidentified data for more than 111 million patients across the United States to identify patients ≥18 years with IBD with prescriptions of a PPI. Patients on PPI were required to have at least 2 prescriptions of a PPI 6 months apart to be included in the analysis. Patients in the IBD-PPI cohort were matched with patients without a history of PPI use (non-PPI group) by using 1:1 propensity score matching. Primary outcomes were the need for intravenous (IV) steroid use or IBD-related surgery within 1-, 2-, and 3 years after PPI initiation. Secondary outcomes included the use of oral steroids, initiation of advanced therapies in biologics-naïve patients, and development of perianal disease.
Results:
Our cohorts included 26,333 patients with ulcerative colitis (UC) (mean age 51.6 ± 19.2, 52.7% female, 75.9% White) and 23,024 patients with Crohn’s disease (CD) (mean age 47.4 ± 18.7, 55.5% female, 76.3% White). At 1 year, patients with UC and CD were more likely to require IV steroids (UC: aOR = 1.94, 95% CI [1.83-1.05], <italic>P =</italic> < 0.001; CD: aOR = 1.65, 95% CI [1.55-0.85], <italic>P =</italic> < 0.001). The increased need for IV steroids persisted in all PPI groups at 2- and 3 years. Similarly, PPI cohorts were at a higher risk for IBD-related surgery at year 1 (UC: aOR = 4.48, 95% CI [3.58-5.61], <italic>P =</italic> < 0.001; CD: aOR = 1.89, 95%CI [1.45–2.46]; <italic>P =</italic> < 0.001) and this finding persisted during 2- and 3-years follow-up. PPI did not affect the risk for perianal disease in patients with CD. Biologic-naïve patients in the PPI cohorts were more likely to use advanced therapies during the follow-up period compared to those in the non-PPI cohort.
Conclusions:
Our results showed that PPI use was associated with worse clinical outcomes in patients with IBD. Although further prospective studies are warranted to validate these findings, caution is warranted when prescribing a PPI for patients with IBD.
