Regular PPI use ups inflammatory bowel disease risk

Regular use of proton pump inhibitors (PPI) seems to slightly aggravate the risk of inflammatory bowel disease (IBD), a recent study has found.

Researchers conducted a pooled analysis of the Nurses’ Health Study (NHS; n=82,869), NHS II (n=95,141), and the UK Biobank study (n=469,397). Over 1,953,244 person-years of follow-up in the NHS and NHS-II cohorts, and 3,768,339 person-years in the UK Biobank, a total of 578 and 1,189 incident cases of Crohn’s disease (CD) and ulcerative colitis (UC) were detected, respectively.

Crude analyses found that in both the UK Biobank and pooled NHS cohorts, PPI use correlated with higher IBD risk. When pooling all three cohorts, regular PPI use increased IBD risk by nearly 80 percent (hazard ratio [HR], 1.76, 95 percent confidence interval [CI], 1.55–2.00).

Such an effect was only slightly attenuated after adjusting for covariates, such as sociodemographic factors, lifestyle, and commonly used medications (adjusted HR, 1.42, 95 percent CI, 1.22–1.65).

Moreover, regular PPI use likewise increased the risk of the IBD subtypes CD (adjusted HR, 1.62, 95 percent CI, 1.27–2.09) and UC (adjusted HR, 1.36, 95 percent CI, 1.02–1.81).

The principal findings were likewise robust to various sensitivity analyses. PPI use remained a risk factor for IBD and its subtypes even after lagging exposure for 4 years, additionally adjusting for metabolic complications and antibiotic use, and propensity-score matching.

“This association should be interpreted with caution as the study design is observational. Besides, the associated absolute risk was modest compared with the well-documented benefits of PPIs for acid-related gastrointestinal disorders,” the researchers said.