PPIs can increase risk of autoimmune disorder in children

A new study published in Frontiers in Pediatrics suggests that reduced gut microbiota diversity has been linked to the development of autoimmune disorders (ADs) and proton pump inhibitors (PPIs).

A class of intricate immunological illnesses known as "autoimmune diseases" are defined by inflammation brought on by a lack of tolerance to self-antigens. This study concentrated on type 1 diabetes (DM), juvenile idiopathic arthritis (JIA), autoimmune thyroiditis (AIT), and inflammatory bowel disorders (IBD), four prevalent pediatric ADs with particularly high frequency in Finland. Worldwide, the prevalence of ADs is rising, and Finland has among the highest rates of pediatric DM, AIT, JIA, and IBD.

Proton pump inhibitors are used to reduce stomach acidity in children with a variety of gastroesophageal conditions, including pediatric eosinophilic esophagitis, Helicobacter pylori eradication, erosive esophagitis healing, peptic ulcer disease treatment, and short-term treatment of symptomatic gastro-esophageal reflux disease (GERD). The purpose of this study by Laura Räisänen and colleagues is to determine if PPI usage throughout infancy is related to the emergence of pediatric onset ADs (represented by DM, JIA, AIT, and IBD).

The Finnish Health in Teens (Fin-HIT) cohort, a national school-based cohort designed to examine the health and health-related behaviors of Finnish children, served as the study population for this matched case-control study. The study's conclusion was a primary autoimmune diagnosis by the time the follow-up period ended on December 31, 2018, when the participants' median age was 16 years. The DPR provided information on PPI purchases using ATC numbers beginning with A02B. Omeprazole (A02BC01), pantoprazole (A02BC02), rabeprazole (A02BC04), lansoprazole (A02BC03), and esomeprazole (A02BC05) were among the several PPIs purchased in this study. These PPIs were examined together.

The key findings of this study were:

1. 46 kids (1.9%) out of the 2,389 kids in this study's sample were exposed to PPIs, totaling 95 transactions.

2. Only 11 kids made additional PPI purchases, and 3 of them got ADs.

3. PPI exposures between the time of birth and the index date were linked to the emergence of ADs, particularly IBD and AIT.

4. In the case group, 67% of PPI purchases were made within two years of the diagnosis, and PPI exposures during this time period were significantly more strongly associated with the emergence of an AD.

5. Compared to children who were not exposed to PPIs, PPI-exposed youngsters made more frequent purchases of antibiotics before the age of three.

6. When the backgrounds of PPI-exposed and non-exposed children were examined, no differences were discovered in terms of sex, preterm delivery, or maternal socioeconomic position.

7. Additionally, only 10 kids in this study were exposed to H2-antagonists, hence no additional research on this medicine was done.

Reference:  

Räisänen, L., Viljakainen, H., & Kolho, K.-L. (2023). Exposure to proton pump inhibitors is associated with the development of pediatric autoimmune diseases. In Frontiers in Pediatrics (Vol. 11). Frontiers Media SA. https://doi.org/10.3389/fped.2023.1157547