Proton pump inhibitors and the risk of inflammatory bowel disease: population-based cohort study

ObjectiveTo determine whether the use of proton pump inhibitors (PPIs) compared with the use of histamine-2 receptor antagonists (H2RAs) is associated with an increased risk of inflammatory bowel disease (IBD). DesignPopulation-based cohort study designed to address the impact of protopathic bias. SettingGeneral practices contributing data to the UK Clinical Practice Research Datalink GOLD. Participants1 498 416 initiators of PPIs and 322 474 initiators of H2RAs from 1 January 1990 to 31 December 2018, with follow-up until 31 December 2019. Patients were analysed according to the timing of the IBD diagnosis after treatment initiation (early vs late). Main outcome measuresStandardised morbidity ratio weighted Cox proportional hazards models were used to estimate marginal HRs and 95% CIs. In the early-event analysis, IBD diagnoses were assessed within the first 2 years of treatment initiation, an analysis subject to potential protopathic bias. In the late-event analysis, all exposures were lagged by 2 years to account for latency and minimise protopathic bias. ResultsIn the early-event analysis, the use of PPIs was associated with an increased risk of IBD within the first 2 years of treatment initiation, compared with H2RAs (HR 1.39, 95% CI 1.14 to 1.69). In contrast, the use of PPIs was not associated with an increased risk of IBD in the late-event analysis (HR 1.05, 95% CI 0.90 to 1.22). The results remained consistent in several sensitivity analyses. ConclusionsCompared with H2RAs, PPIs were not associated with an increased risk of IBD, after accounting for protopathic bias.

Automated summary

This study aimed to determine whether the use of proton pump inhibitors (PPIs) is associated with an increased risk of inflammatory bowel disease (IBD) compared to histamine-2 receptor antagonists (H2RAs). It was a population-based cohort study that considered the impact of protopathic bias and conducted sensitivity analyses to ensure the accuracy of the results. The conclusion was that there is no association between the use of PPIs and an increased risk of IBD when accounting for protopathic bias, in contrast to H2RAs.