In the Journals

Antisecretory medications linked to risk for celiac disease

Patients who had previously been prescribed antisecretory medications, including proton pump inhibitors and histamine-2 receptor antagonists, were at increased risk for developing celiac disease in a recent study.

In a population-based, case-control study in Sweden, researchers evaluated the use of proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) among 2,934 patients (mean age, 33 years; 61% female) diagnosed with celiac disease (CD) between July 2005 and February 2008, along with 14,584 matched controls.

One or more prior PPI prescriptions was noted in 6.3% of the cohort, with patients with CD significantly more likely to have a previous prescription than controls (16% of patients compared with 4% of controls; OR=4.79; 95% CI, 4.17-5.51). This association was observed in males (OR=5.1; 95% CI, 4.1-6.36) and females (OR=4.59; 95% CI, 3.84-5.5), and was most pronounced among patients aged younger than 20 years (OR=14.66; 95% CI, 8.04-26.75).

Sensitivity analysis in which patients or controls with initial PPI exposure within 1 year before CD diagnosis were excluded did not eliminate the link between PPI use and CD risk (OR=2.28; 95% CI, 1.67-3.1).

Prescriptions for any antisecretory medications also were significantly more frequent in patients with CD (OR=4.87; 95% CI, 4.26-5.56). The risk for celiac disease was greater among patients who had previously been prescribed PPIs and H2RAs (OR=5.96; 95% CI, 3.58-9.91) than among those prescribed either medication alone (OR=4.91; 95% CI, 4.26-5.66 for PPIs; OR=4.16; 95% CI, 2.89-5.99 for H2RAs). The association also existed regardless of the number of prior prescriptions, and across all evaluated PPIs except rabeprazole (P=.3685).

“We found that exposure to acid-suppressing medication was strongly associated with a subsequent diagnosis of CD,” the researchers wrote. “We also found that this association was most robust in younger individuals, and in subjects who were exposed to both H2RAs and PPIs. These findings should prompt future studies to elucidate the mechanism by which PPIs or acid suppression in general affects the pathogenesis of CD.”

Disclosure: The researchers report no relevant financial disclosures.

Patients who had previously been prescribed antisecretory medications, including proton pump inhibitors and histamine-2 receptor antagonists, were at increased risk for developing celiac disease in a recent study.

In a population-based, case-control study in Sweden, researchers evaluated the use of proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) among 2,934 patients (mean age, 33 years; 61% female) diagnosed with celiac disease (CD) between July 2005 and February 2008, along with 14,584 matched controls.

One or more prior PPI prescriptions was noted in 6.3% of the cohort, with patients with CD significantly more likely to have a previous prescription than controls (16% of patients compared with 4% of controls; OR=4.79; 95% CI, 4.17-5.51). This association was observed in males (OR=5.1; 95% CI, 4.1-6.36) and females (OR=4.59; 95% CI, 3.84-5.5), and was most pronounced among patients aged younger than 20 years (OR=14.66; 95% CI, 8.04-26.75).

Sensitivity analysis in which patients or controls with initial PPI exposure within 1 year before CD diagnosis were excluded did not eliminate the link between PPI use and CD risk (OR=2.28; 95% CI, 1.67-3.1).

Prescriptions for any antisecretory medications also were significantly more frequent in patients with CD (OR=4.87; 95% CI, 4.26-5.56). The risk for celiac disease was greater among patients who had previously been prescribed PPIs and H2RAs (OR=5.96; 95% CI, 3.58-9.91) than among those prescribed either medication alone (OR=4.91; 95% CI, 4.26-5.66 for PPIs; OR=4.16; 95% CI, 2.89-5.99 for H2RAs). The association also existed regardless of the number of prior prescriptions, and across all evaluated PPIs except rabeprazole (P=.3685).

“We found that exposure to acid-suppressing medication was strongly associated with a subsequent diagnosis of CD,” the researchers wrote. “We also found that this association was most robust in younger individuals, and in subjects who were exposed to both H2RAs and PPIs. These findings should prompt future studies to elucidate the mechanism by which PPIs or acid suppression in general affects the pathogenesis of CD.”

Disclosure: The researchers report no relevant financial disclosures.