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Drugs that inhibit gastric acid secretion may alter the course of inflammatory bowel disease
Author(s) -
Juillerat P.,
Schneeweiss S.,
Cook E. F.,
Ananthakrishnan A. N.,
Mogun H.,
Korzenik J. R.
Publication year - 2012
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2012.05173.x
Subject(s) - medicine , ulcerative colitis , inflammatory bowel disease , incidence (geometry) , gastroenterology , rate ratio , cohort , relative risk , disease , crohn's disease , cohort study , confidence interval , physics , optics
Summary Background Recent data suggest that acid suppressive medications may alter factors central to the pathophysiology of inflammatory bowel diseases ( IBD ), whether through shifts in the intestinal microbiome due to acid suppression or effects on immune function. Aim To assess the relationship between the use of proton pump inhibitors ( PPI s) or histamine2‐receptor antagonists ( H 2 R a) and incidence of ‘flares’ (hospitalisation/surgery and change in medication). Methods We conducted a new user cohort study including individuals diagnosed with IBD in B ritish C olumbia using linked healthcare utilisation databases (available from J uly 1996 through A pril 2006). Propensity‐score matched incidence rates during a 6‐month follow‐up period and rate ratios ( RR ) and 95% CI were calculated. Results Among 16 151 IBD patients, 1307 C rohn's disease ( CD ) and 996 ulcerative colitis ( UC ) patients experienced a new use of PPI s, whereas 741 CD and 738 UC used H 2 R a. All IBD subgroups were matched separately to an equal number of unexposed IBD patients. H 2 R a use in CD doubled the risk of hospitalisation/surgery ( RR = 1.94; 95% CI 1.24–3.10) and numerically less so in UC patients ( RR = 1.11) with widely overlapping CI s (0.61–2.03). Proton pump inhibitors use was associated with medication change in UC ( RR = 1.39; 95% CI 1.20–1.62), but without meaningfully, increased risk of hospitalisation/surgery for UC or CD patients. Extending follow‐up showed persistence, but attenuation, of all effects. Conclusions Initiation of PPI s or H 2 R a may be associated with short‐term changes in the course of IBD . Although confounding by indication was adjusted using propensity score matching, residual confounding may persist and findings need to be interpreted cautiously.