Abstract
Introduction
Proton pump inhibitors (PPIs) are one of the most commonly prescribed medications in the United States. Some recent studies have suggested that PPIs may have a negative effect on the gut microbiome. Dysbiosis of the gut microbiome has been linked with inflammatory bowel disease (IBD). We hypothesized that PPI use is associated with increased IBD flares and activity. This study was aimed to assess the effect of PPIs on IBD flares and activity.
Methods
We conducted a prospective longitudinal study of Veterans from the IBD clinic at the Michael E. DeBakey VA Medical Center from 2014 to 2018. Our eligibility criteria included patients who were at least 18 years of age, who were diagnosed with Crohn’s Disease (CD) or Ulcerative Colitis (UC), and who had at least 2 clinic visits. IBD flare was defined by patient self-report of IBD flare between clinical encounters. IBD activity was quantified using the partial Mayo Score (pMayo) for UC, and the Harvey Bradshaw Index (HBI) for CD. Remission was defined by pMayo< 2 for UC and HBI< 5 for CD. The exposure of PPI was confirmed by chart review. Associations of PPI use with IBD flare and activity were assessed using T-tests and Chi-squared tests.
Results
A total of 132 patients were included in the analysis of which 74 had CD and 58 had UC. 40 patients were PPI users, and IBD flares occurred in 60 patients. No significant association between PPI usage and IBD flares were observed: 42.5% of PPI users developed flares compared to 46.7% of non-PPI users who developed flares, p-value=0.658. In patients with CD, PPI use was associated with non-remission status (RR 2.53; 95% CI 1.04–6.15). In UC patients, PPI use was not associated with non-remission status (RR 1.10; 95% CI 0.67 - 1.79). 13 CD patients on PPIs discontinued the PPI between encounters, which was associated with a statistically significant decrease in HBI (3.62 to 2.54, p-value= 0.005). Among UC patients who discontinued PPIs, there was a non-significant trend towards decreased pMayo (2.26 to 1.59, p-value= 0.069).
Discussion
Amongst CD patients, PPI use was not associated with interval flare however it was associated with non-remission status. Cessation of PPIs was associated with a statistically significant decrease in HBI in CD patients. Amongst UC patients, no significant associations between PPI use and flare or activity were observed. Decreasing unnecessary PPI use in patients with CD may decrease disease severity.
P020 Proton Pump Inhibitor Therapy: Providing “Acid” Outcomes in Patients With Inflammatory Bowel Disease Under Infliximab Treatment
