Proton pump inhibitors associated with worse outcomes in CD

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 [3].

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 [4].

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.

1. Bruno G, et al. World J Gastroentereol. 2019;25:2706–19.
2. Imhann F, et al. 2016;65(5):740–8.
3. Xia B, et al. Gastroenterology. 2021;161:1842–52.
4. 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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Posted on 4 May 20238 April 2024