In patients with CD, exposure to proton pump inhibitors is an independent risk factor for worse treatment outcomes and shorter survival.

There is an ongoing debate regarding the impact of proton pump inhibitors (PPIs) on the evolution of IBD. Previous work has shown that the gut microbiome of PPI users and patients with IBD have certain common characteristics, such as decreased diversity and an abundance of potentially pathogenic species, suggesting PPI use may be associated with IBD. To shed light on this issue, Dr. Stéphanie Barrau of Saint Etienne University Hospital in France, and colleagues conducted a single-center, retrospective cohort study among consecutive adult patients with Crohn’s disease or ulcerative colitis.

All patients were followed prospectively over a 4-month period. PPI use was defined as PPI exposure for a duration of more than 7 days after IBD diagnosis until the end of follow-up. In this period, the researchers assessed a possible association of PPI exposure with treatment failure, defined as an IBD-related surgery or hospitalization and/or failure with more than four biologic treatments, including TNF-blockers, vedolizumab, and ustekinumab).

The analysis included 244 patients, of which 113 (46%) had been previously exposed to a PPI. In total, 152 patients (62%) experienced treatment failure. PPI use was identified as an independent factor associated with treatment failure (P=0.025). In a subgroup analysis by IBD type, this association remained significant only for CD (P=0.005), not UC. PPI use was not associated with risk for immunogenicity in the subgroup of patients treated with infliximab.

Importantly, survival without treatment failure was significantly longer in patients who were not exposed to PPI (325 months) compared with those with PPI exposure (228 months; P=0.022). Therefore, the authors suggest that the use of PPIs in patients with CD should be discussed on a case-by-case basis.

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