Do proton pump inhibitors aggravate clinical outcomes in patients with Crohns disease?

Abstract

Background: The aim of the present study was to evaluate the effects of proton pump inhibitors (PPIs) on the clinical course of Crohns disease (CD).

Methods: All patients with CD followed up at Seoul National University Hospital between 2005 and 2013 who were treated with PPIs were matched 1:2 to PPI-naive CD patients. The incidence rates of severe flare-up (operation or hospitalization) and mild flare-up (medication change) during a 6-month follow-up period were evaluated.

Results: No differences in age, sex, disease duration, associated diseases, or anal involvement were observed between the 38 patients treated with PPIs and the 76 control subjects. In the group exposed to PPIs, more patients had ileal involvement and history of prior hospitalization or operation. Concurrent treatment with azathioprine and 5-amino-salicylates was more prevalent in the control group, whereas changes in medication during the 6-month covariate assessment period were significantly more frequent in the group exposed to PPIs. However, after adjusting these confounding factors using multivariate binary logistic regression, the PPI use in the CD patients significantly increased the risk of severe flare-up (odds ratio, 6.90

95% confidence interval, 1.11–42.85) and mild flare-up (odds ratio, 14.66

95% confidence interval, 3.38–63.63). The Kaplan-Meier curve showed that the incidence of both severe and mild flare-ups were significantly higher in the group exposed to PPIs than in the control group (P<0.001).

Conclusions: The use of PPIs may be associated with poor prognosis in CD. Medical practitioners should pay special attention when prescribing PPIs for CD patients.