PPIs do not increase risk of inflammatory bowel disease

After adjusting for protopathic bias, proton pump inhibitors (PPIs) were not linked to a higher risk of inflammatory bowel disease (IBD) compared to histamine-2 receptor antagonists (H2RAs), says an article published in British Medical Journal.

The gut flora and immune system are significantly impacted by proton pump inhibitors, which may raise the risk of inflammatory bowel disease. To ascertain if the usage of proton pump inhibitors as opposed to the use of histamine-2 receptor antagonists is linked to a higher risk of inflammatory bowel disease, Devin Abrahami and colleagues undertook this investigation.

The purpose of this population-based cohort research was to examine the effects of protopathic prejudice. For this project, general practices agreed to contribute data to the UK Clinical Practice Research Datalink GOLD.1 498 416 PPI initiators and 322 474 H2RA initiators between January 1, 1990, and December 31, 2018, with follow-up through December 31, 2019. Patients were evaluated based on how soon (early vs. late) after the start of medication the IBD diagnosis was made.

To calculate marginal HRs and 95% CIs, standard morbidity ratio weighted Cox proportional hazards models were utilized. The early-event analysis, which was susceptible to protopathic bias, evaluated IBD diagnoses during the first two years after treatment beginning. To account for latency and reduce protopathic bias, all exposures were delayed by 2 years in the late-event analysis.

The key findings of this study were:

1. When compared to H2RAs, the use of PPIs was found to be related with a higher risk of IBD during the first two years after treatment beginning (HR 1.39, 95% CI 1.14 to 1.69).

2. In contrast, the late-event analysis found no link between PPI usage and an elevated risk of IBD (HR 1.05, 95% CI 0.90 to 1.22).

3. Multiple sensitivity analysis showed that the results held true.

Reference:

Abrahami, D., Pradhan, R., Yin, H., Yanofsky, R., McDonald, E. G., Bitton, A., & Azoulay, L. (2023). Proton pump inhibitors and the risk of inflammatory bowel disease: population-based cohort study. In Gut (Vol. 72, Issue 7). BMJ. https://doi.org/10.1136/gutjnl-2022-328866