title: Gastric Acid Suppression Is Associated with an Increased Risk of Adverse Outcomes in Inflammatory Bowel Disease.
abstract: BACKGROUND
  The intestinal microbiota may influence inflammatory bowel disease (IBD) activity. Histamine 2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) can alter the intestinal microbiota. The aim of this study was to assess the relationship between H2RAs, PPIs, and IBD-related outcomes.
  
  
  METHODS
  We conducted a case-control study of IBD patients using the Veterans Health Affairs databases. Cases were defined by their first instance of an IBD-related hospitalization or surgery and the exposure of interest was H2RA or PPI use 30 days prior to the outcome. Incidence density ratios were calculated using conditional logistic regression.
  
  
  RESULTS
  In a cohort of 58,459 patients with IBD, we found 4,887 cases and 9,761 controls with ulcerative colitis (UC) and 4,876 cases and 9,745 controls with Crohn disease (CD). Filled prescriptions for H2RAs were associated with an increased risk of IBD-related hospitalization or surgery in CD patients (adjusted incidence density ratio 1.18; 95% CI 1.03-1.34). A similar association was found for PPIs in UC patients (adjusted incidence density ratio 1.11; 95% CI 1.02-1.21) and CD patients (adjusted incidence density ratio 1.12; 95% CI 1.02-1.22).
  
  
  CONCLUSIONS
  H2RAs and PPIs were associated with a modestly increased risk of IBD-related hospitalization or surgery.
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Shah
authors.forename: Peter
authors.initials: P
authors.lastname: Richardson
authors.forename: Hong
authors.initials: H
authors.lastname: Yu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kramer
authors.forename: Jason Ken
authors.initials: JK
authors.lastname: Hou
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D000069196:Gastrointestinal Microbiome / Q000187:drug effects*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors
keywords: Crohn’s disease; Histamine 2 receptor antagonists; Inflammatory bowel disease; Proton pump inhibitors; Ulcerative colitis