Proton pump inhibitors might increase risk of respiratory infections in cystic fibrosis patients

Since prolonged proton pump inhibitors (PPI) medication may raise the chance of respiratory infection by P. aeruginosa (Pa), it should be used with caution in people with cystic fibrosis (pwCF), says an article published in Digestive and Liver Diseases.

In order to treat gastro-esophageal reflux disease in patients with a variety of comorbidities, such as chronic respiratory diseases like asthma, chronic obstructive pulmonary disease, pulmonary arterial hypertension, and idiopathic pulmonary fibrosis, proton pump inhibitors (PPIs), a class of antacid medications, are available by prescription and over-the-counter. Limited research has been done on the efficacy of proton pump inhibitors as adjuvant therapy to treat maldigestion in cystic fibrosis patients, and worry over potential adverse effects is growing. The purpose of this study, which was carried out by Laura Zazzeron and colleagues, was to evaluate the effectiveness of proton pump inhibitors in cystic fibrosis patients.

A matched cohort study using pediatric and adult people with cystic fibrosis who took PPI for around three months was carried out by researchers. Utilizing a nearest neighbor propensity score matching based on sex, year of birth, CFTR genotype, and pancreatic insufficiency, treated patients were matched to a group of patients who never received PPI.

The key findings of this study were:

1. 160 pwCF were included in the trial, 80 of them received treatment and 80 did not.

2. No discernible differences in the changes in BMI z-score across groups were seen over a median follow-up of 2 years (adjusted mean difference: 0.06, 95% CI: -0.17-0.30).

3. At the beginning, P. aeruginosa was detected in the cultures of 25.5% (n = 20) of the treated patients and 22.5% (n = 18) of the untreated patients.

4. In the treated group, the proportion of Pa positive cultures rose to 47.5% (n = 38) at the follow-up visit, whereas it dropped to 26.3% (n = 21) in the untreated group (adjusted mean difference: 23.1%, 95% CI: 10.8-35.3).

Reference:

Zazzeron, L., Alicandro, G., Daccò, V., Lanfranchi, C., Bulfamante, A., Sciarrabba, C. S., Corti, F., & Colombo, C. (2022). Effects of prolonged proton pump inhibitor treatment on nutritional status and respiratory infection risk in cystic fibrosis: A matched cohort study. In Digestive and Liver Disease. Elsevier BV. https://doi.org/10.1016/j.dld.2022.09.005