Does Regular use of Proton Pump Inhibitors Influence IBD Diagnosis?

A recent pooled analysis from three separate observational studies found that individuals taking proton pump inhibitors (PPIs) had a moderately increased risk of developing IBD. PPIs are commonly referred to as heartburn medication and can be purchased over the counter. Common brands include Prilosec, Prevacid, and Nexium. These medications work by slowing stomach acid production, aiding in symptoms of GERD, esophageal and stomach ulcers, acid reflux, and much more. However, there has been some concern as of late to the long-term efficacy and safety of this drug. This particular Chinese study focused only on the development of IBD and gathered their data from the Nurses’ Health studies I & II and U.K. Biobank cohort. 

This mitiveritve analysis showed that those who took PPIs on a regular basis had an increased hazard ratio of 1.42 compared to those who didn’t. They even compared the hazard ratio of a similar medication known as H2 blockers. These medications also reduce stomach acid but block production later in the day. The hazard ratio for H2 blockers came in at 1.38 in comparison. Findings for both Crohn’s and Ulcerative Colitis were consistent with each other, having a hazard ratio of 1.62 and 1.36 respectively. These analyses also accounted for the underlying conditions for which the PPIs were being taken, creating a more accurate hazard ratio. The overall absolute risk was found to be 26.52 out of every 100,000 people. 

The researchers also found some other correlating factors in addition to repetitive PPI use. Interestingly enough, those that took PPIs on a regular basis were more likely to smoke, be overweight, less active, take NSAIDs, and suffer from either GERD, upper gastrointestinal bleeding, or gastric ulcers. Long-term use of PPIs has been associated with alteration of the gut microbiome. Possibly the reason for gut dysbiosis leading to active disease. This seems more likely the case even still if you consider the factors of smoking, obesity, NSAIDs, and other gastrointestinal issues, as all these change the biome as well. Over time, compromised gut microbiomes in addition to other lifestyle factors can lead to poor overall health.

This study is very intriguing and will hopefully lead to more research in the area of long-term PPI use and IBD. Although groundbreaking, the researchers noted that “This association should be interpreted with caution as the study design is observational,” They also added, “The associated absolute risk was modest as compared with the well-documented benefits of PPIs for acid-related gastrointestinal disorders.” So, while these medications may need to be used in potentially lesser quantities, they do a good job of stopping acid production and aiding in reducing symptoms of upper GI disorders. As with any medication, there are benefits as well as potential risks. While we don’t know for certain what causes IBD, every study brings us closer to unlocking these complex diseases. 

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