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PROTON PUMP INHIBITORS ARE ASSOCIATED WITH A DISABLING COURSE OF CROHN’S DISEASE

Mathilde BARRAU 1, Gerard Duru 2, Anne-Sophie Peaucelle 3, Stephane NANCEY 4, Adam Cheifetz 5, Konstantinos Papamichael 5, Stéphane Paul 6, Xavier Roblin 1

Affiliations

1 University of Saint Etienne, Saint Etienne, France

2 Laude Bernard University, Lyon, France

3 Saint Etienne University Hospital, Saint Etienne, France

4 Lyon-Sud University Hospital, Lyon, France

5 Beth Israel Deaconess Medical Center, Boston, United States

6 Hôpital Nord, Saint Etienne, France

Summary

AI Generated

A single-center retrospective cohort study of 244 IBD patients found that proton pump inhibitor exposure was independently associated with treatment failure in Crohn disease but not ulcerative colitis.

Among 244 adults with IBD (152 with Crohn disease), 46 percent had been exposed to a proton pump inhibitor for more than seven cumulative days from diagnosis.
Proton pump inhibitor use was an independent factor associated with treatment failure, defined as IBD-related surgery or hospitalization and/or failure of more than four biologic treatments (hazard ratio 1.920, 95 percent CI 1.084 to 3.403, p equals 0.025).
In subgroup analysis, the association remained statistically significant for Crohn disease (hazard ratio 3.190, p equals 0.005) but not for ulcerative colitis (hazard ratio 0.981, p equals 0.968).
Survival without treatment failure was significantly higher in patients without proton pump inhibitor exposure compared to those with exposure (175 months versus 119 months, p equals 0.033).
The authors conclude that proton pump inhibitor use should be discussed on a case-by-case basis in patients with Crohn disease.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

The impact of proton pump inhibitors (PPIs) on the evolution of inflammatory bowel disease (IBD) remains debated with only sparse data available. The primary objective of this study was to analyze the impact of PPIs on the course of IBD.

Aims & Methods

This was a single-center, retrospective cohort study. We included consecutive adult patients diagnosed with Crohn disease (CD) or ulcerative colitis (UC) who were followed prospectively in our day hospital over a 4-month period (from May to August 2022). PPI exposure was defined as PPI use for a cumulative duration of more than seven days from the date of IBD diagnosis until the end of follow-up. We performed a time to event analysis to investigate the association of PPI exposure with treatment failure defined as an IBD- related surgery or hospitalization and/or failure for more than four biologic treatment (Anti TNF, Vedolizumab, Ustekinumab).

Results

Among the 281 patients identified, 244 patients were eligible for analysis of the primary objective (152 with CD, mean age 45 years, sex ratio 1:1). 113 (46%) patients had been previously exposed to a PPI. PPI-exposed patients were significantly older (p=0.013), more often women (p=0.029), with more frequent active smoking (p=0.001). A total of 152 patients (62%) had treatment failure. Using Cox regression analysis, (Table 1), PPI use identified as an independent factor associated with treatment failure (HR = 1.920; 95% CI [1.084-3.403]; p0.025). In a subgroup analysis by IBD type, this remained statistically significant only for CD (HR = 3.190; 95% CI (1.412-7.206); p 0.005) but not for UC (HR = 0.981; 95% CI (0.384-2.504); p0.968). Survival without treatment failure (Figure 1) was significantly higher in patients without PPI exposure compared to patients with PPI exposure (175 months vs. 119 months, respectively, p=0.033 Log-Rank). In a subgroup analysis of infliximab-treated patients, PPI use was not associated with risk of immunogenicity (HR = 1.071; 95% CI (0.515-2.226); p0.854).

Conclusion

This study demonstrates the negative impact of PPIs on the disease course in patients with CD. The use PPIs should better be discussed on a case-by-case basis.

Disclosure

None

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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APPLICATION AND VALIDATION OF MILAN ULTRASOUND CRITERIA IN A LARGE COHORT OF 181 PATIENTS WITH ULCERATIVE COLITIS: A MULTICENTER REAL WORLD ITALIAN STUDY

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APPLICATION AND VALIDATION OF MILAN ULTRASOUND CRITERIA IN A LARGE COHORT OF 181 PATIENTS WITH ULCERATIVE COLITIS: A MULTICENTER REAL WORLD ITALIAN STUDY

Mariangela Allocca 1, Alessandra Zilli 1, Fulvia Terracciano 2, Giovanni Cataletti 3, Arianna Dal Buono 4, Cristina Bezzio 4, Mirella Fraquelli 5, Emma Calabrese 6, Francesca Zorzi 6, Antonio Rispo 7, Alice De Bernardi 8, Federica Furfaro 1, Cosimo Simone Matichecchia 9, Ilaria Faggiani 1, Ferdinando D'Amico 1, Simona Radice 4, Antonella Marra 10, Simone Saibeni 8, Flavio Caprioli 5, Giovanni Maconi 11, Fabiana Castiglione 7, Alessandro Armuzzi 4, Gionata Fiorino 12, Silvio Danese 1

Affiliations

1 IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milano, Italy

2 Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy

3 Department Biomedical and Clinical Sciences, "L. Sacco" University Hospital, Milan, Italy

4 IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

5 Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy

6 University of Rome Tor Vergata, Rome, Italy

7 University ´´Federico II´´of Naples, Naples, Italy

8 ASST Rhodense, Rho, Italy

9 Vita e Salute San Raffaele University, Milan, Italy

10 IRCSS Saverio de BELLIS, Castellana Grotte, Italy

11 Luigi Sacco University Hospital Gastroenterology Unit Biomed and Clinical Sciences, Milan, Italy

12 San Camillo-Forlanini Hospital, Rome, Italy