The use of proton pump inhibitors (PPI) was associated with an increased risk of treatment failure in patients with Crohn´s disease (CD). In addition, survival without treatment failure was significantly longer in patients who were not exposed to PPI.
Previous studies have shown that the gut microbiomes of PPI users and patients with IBD have certain commonalities, such as decreased diversity and abundance of Faecalibacterium and an increased number of potentially pathogenic species, such as E. coli and C. difficile, suggesting that PPI use may be associated with IBD [1,2]. In addition, a pooled analysis of 3 prospective studies revealed that regular PPI uses was associated with an increased risk of IBD and its subtypes .
To explore this issue further, Dr Stéphanie Barrau (Saint Etienne University Hospital, France) performed a single-centre, retrospective, cohort study, that included adult patients diagnosed with CD or ulcerative colitis .
All participants were followed up prospectively for 4 months. PPI use was defined as PPI exposure for more than 7 days after IBD diagnosis until the end of follow-up. During this time, the authors assessed a possible association between PPI exposure and treatment failure defined as an IBD-related surgery or hospitalisation and/or failure for more than 4 different biologic treatments (i.e. TNF blockers, vedolizumab, and ustekinumab).
Of the 244 participants included in the analysis, 113 (46%) had previously been exposed to PPI. A total of 152 participants (62%) experienced treatment failure. PPI use was identified as an independent factor associated with treatment failure (P=0.025). In a subgroup analysis by IBD type, this association remained significant only for CD (P=0.005) but not for ulcerative colitis. PPI use was not associated with immunogenicity risk in the subgroup of participants treated with infliximab.
Importantly, survival without treatment failure was significantly longer in participants who were not exposed to PPI (325 months) than in those who were exposed to PPI (228 months; P=0.022). Therefore, the authors suggest that the use of PPIs in patients with CD should be discussed on a case-by-case basis.
- Bruno G, et al. World J Gastroentereol. 2019;25:2706–19.
- Imhann F, et al. 2016;65(5):740–8.
- Xia B, et al. Gastroenterology. 2021;161:1842–52.
- Barrau M, et al. Proton pump inhibitors are associated with a disabling course of Crohn’s disease. P325, ECCO 2023, 01–04 March, Copenhagen, Denmark.
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Table of Contents: ECCO 2023
Letter from the Editor
ECCO 2023 Highlights Podcast
What Is New in Biologic Therapy?
Beneficial effect of early, post-operative vedolizumab on endoscopic recurrence in CD
Long-term data supports the established efficacy and safety of ustekinumab in UC
Anti-TNF withdrawal may be a safe option in stable IBD
Intensified drug therapy leads to better stricture morphology in CD
Small Molecules in IBD: State of the Art
Continued efficacy of long-term ozanimod as UC treatment
Upadacitinib successful in the management of both CD and UC
Solid results for long-term therapy of UC with filgotinib
Paediatric IBD: What You Need To Know
Perinatal period is crucial for the risk of developing CD
Early-life antibiotic exposure: a risk factor for paediatric-onset IBD
Paediatric patients with immune-mediated inflammatory disease harbour a heightened cancer risk
Risk Factors and Complications of IBD
Checking kidney function is important during the course of IBD
Diabetes therapy with GLP-1-based drugs does not elevate the risk of IBD
Surgical Approaches: New Developments
Long-term resection potentially better than anti-TNF treatment in CD
Early, post-operative complications in CD reduced by pre-operative enteral nutrition, irrespective of biologic exposure
Pearls of the Posters
Drop in overall IBD procedures during the pandemic
Proton pump inhibitors associated with worse outcomes in CD
Poor sleep in CD linked to low levels of vitamin D
Novel AI tool assessing mucosal inflammation achieves high correlation with histopathologists