Proton Pump Inhibitor Use Before and After a Diagnosis of Inflammatory Bowel Disease

Proton pump inhibitors (PPIs) have an impact on the gut microbiome. We investigated whether increased use of PPIs was associated with a diagnosis of inflammatory bowel disease (IBD).The University of Manitoba IBD Epidemiology Database includes all Manitobans diagnosed with IBD between 1984 and 2018 with age-, sex-, and geography-matched control subjects and comprehensive prescription drug data from April 1995. Subjects were considered to be users if they received 2 PPI prescriptions. We assessed PPI prescriptions prediagnosis and for 3 years postdiagnosis of IBD. The absolute and relative rates were calculated and compared for PPI use pre- and post-IBD diagnosis.A total of 5920 subjects were diagnosed with IBD after April 1996. Rates of PPI use in control subjects increased gradually from 1.5% to 6.5% over 15 years. Persons with IBD had a higher rate of PPI use, peaking up to 17% within 1 year of IBD diagnosis with a rate ratio (RR) of 3.1 (95% confidence interval [CI], 2.9-3.3). Furthermore, persons with Crohn's disease (RR, 4.2; 95% CI, 3.7-4.6) were more likely to have been PPI users prediagnosis than persons with ulcerative colitis (RR, 2.4; 95% CI, 2.2-2.7). Important predictors of increased PPI use were older age, year of data collection, and Crohn's disease diagnosis.Persons with IBD have higher PPI use preceding their diagnosis. Possibly, the use of a PPI alters the gut microbiome, increasing the risk for IBD diagnosis; or persons with IBD have increased rates of dyspepsia, warranting PPI use; or some IBD symptoms are treated with PPIs whether warranted or not.Proton pump inhibitor (PPI) use is increased in persons with IBD for up to years prior to their diagnosis, raising the possibility that their use increases the risk for inflammatory bowel disease (IBD), or alternatively, persons with IBD have more upper gastrointestinal complaints. Another possibility is that early IBD-related symptoms are being managed rightly or wrongly with PPI therapy. Further, there is an increased use of PPI therapy post–IBD diagnosis compared with matched control subjects. While the use of PPI therapy in persons with IBD may be appropriate, physicians need to rigorously review their use at all times, especially in persons with IBD, as in this population their use may be excessive and possibly detrimental.