Use of proton pump inhibitors and subsequent risk of celiac disease

Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
Digestive and Liver Disease (Impact Factor: 2.96). 09/2013; 46(1). DOI: 10.1016/j.dld.2013.08.128
Source: PubMed


The prevalence of celiac disease and the use of medications that inhibit acid secretion have both increased in recent decades.
To explore the association between antisecretory medication exposure and subsequent development of celiac disease.
In this population-based case control study, we identified patients with celiac disease diagnosed at all pathology departments in Sweden from July 2005 through February 2008. Patients were matched by age and gender with up to 5 controls. We identified prior prescriptions for proton pump inhibitors and histamine-2 receptor antagonists in all subjects. We used conditional logistic regression to measure the association between these prescriptions and the subsequent diagnosis of celiac disease.
Prior proton pump inhibitor prescription was strongly associated with celiac disease (OR 4.79; 95% CI 4.17-5.51). Patients prescribed both proton pump inhibitors and histamine-2 receptor antagonists had a higher risk of celiac disease (OR 5.96; 95% CI 3.58-9.91) than those prescribed proton pump inhibitors alone (OR 4.91; 95% CI 4.26-5.66) or histamine-2 receptor antagonists alone (OR 4.16; 95% CI 2.89-5.99).
Exposure to antisecretory medications is associated with a subsequent diagnosis of celiac disease. The persistence of this association after excluding prescriptions in the year preceding the celiac disease diagnosis suggests a causal relationship.

Download full-text


Available from: Peter H R Green, Apr 07, 2014
39 Reads
  • Source
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 11/2013; 12(4). DOI:10.1016/j.cgh.2013.10.031 · 7.90 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) are not mutually exclusive. The notion that GERD and EoE can be distinguished by the response to proton pump inhibitor (PPI) treatment is based on the mistaken assumption that gastric acid suppression is the only important therapeutic effect of PPIs, and therefore only GERD can respond to PPIs. We believe that a clinical or histologic response to PPIs does not rule in GERD or rule out EoE. We recommend a trial of PPI therapy for patients with symptomatic esophageal eosinophilia, even if the diagnosis of EoE seems clear-cut.
    Gastroenterology clinics of North America 06/2014; 43(2):243-256. DOI:10.1016/j.gtc.2014.02.004 · 2.82 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Potent gastric acid suppression using proton pump inhibitors (PPIs) is common in clinical practice but may have important effects on human health that are mediated through changes in the gastrointestinal microbiome. In the esophagus, PPIs change the normal bacterial milieu to decrease distal esophageal exposure to inflammatory gram-negative bacteria. In the stomach, PPIs alter the abundance and location of gastric Helicobacter pylori and other bacteria. In the small bowel, PPIs cause polymicrobial small bowel bacterial overgrowth and have been associated with the diagnosis of celiac disease. In the colon, PPIs associate with incident but not recurrent Clostridium difficile infection. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinics in Laboratory Medicine 12/2014; 34(4). DOI:10.1016/j.cll.2014.08.008 · 1.37 Impact Factor
Show more