Abstract & Authors:展开
BACKGROUND & AIMS: Proton pump inhibitors (PPIs) have a major impact on gut microbiome and immune function which in turn, may increase the risk of inflammatory bowel disease (IBD). We undertake this study to evaluate PPI use and subsequent risk of IBD and subtypes (Crohn's disease [CD] and ulcerative colitis [UC]).
METHODS: This is a pooled analysis of Nurses’ Health Study (NHS, n=82 869), NHS II (n=95 141) and UK Biobank (n=469 397). We included participants with information on personal use of PPIs and free of IBD or cancer at baseline. We evaluated hazard ratios (HRs) and 95% confidence intervals (CIs) with COX regression adjusting for lifestyle factors, PPI indications, comorbidities, and other medications.
RESULTS: We documented 271 cases of IBD (median follow-up:12 years) in the pooled NHS cohorts and 1419 cases (median follow-up:8.1 years) in the UK Biobank. For both pooled NHS cohorts and UK Biobank, regular use of PPIs consistently showed a significantly positive association with IBD, CD and UC risk. Combined analyses of three cohorts showed that regular PPI users had an increased risk of IBD as compared with non-users (HR 1.42, 95%CI 1.22 to 1.65; number needed to harm 3 770, 95% CI 3 668 to 4 369). Direct comparison with H2 receptor antagonist, a less potent acid suppressor, showed that PPI use was also associated with higher IBD risk (HR 1.38, 95%CI 1.16 to 1.65).
CONCLUSIONS: Regular use of PPIs was associated with an increased risk of IBD and its subtypes. The findings should be interpreted with caution because the absolute risk was low and the clinical benefits of PPIs are substantial.
Changhua Zhang,Wenbo Meng,Jinqiu Yuan
Bin Xia,Man Yang,Long H Nguyen,Qiangsheng He,Jie Zhen,Yuanyuan Yu,Mengyang Di,Xiwen Qin,Kuiqing Lu,Zi Chong Kuo,Yulong He,Changhua Zhang,Wenbo Meng,Jinqiu Yuan