PROTON-PUMP INHIBITORS ARE ASSOCIATED WITH AN INCREASED RISK OF MICROSCOPIC COLITIS: A POPULATION-BASED STUDY AND REVIEW OF THE LITERATURE.

Q2 Medicine Arquivos de Gastroenterologia Pub Date : 2024-10-21 eCollection Date: 2024-01-01 DOI:10.1590/S0004-2803.24612024-053
Rashid Abdel-Razeq, Antoine Boustany, Somtochukwu Onwuzo, Mustafa Saleh, Riya Gupta, Hadi Khaled Abou Zeid, Chidera N Onwuzo, David Farhat, Mimi Najjar, Abdallah El Alayli, Imad Asaad
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Patients usually present with chronic watery and non-bloody diarrhea and are typically characterized by an unremarkable gross appearance of the colon on lower endoscopy while having evidence of lymphocytic infiltration of the lamina propria and the epithelium on histology. Two subtypes have been described in the literature: Collagenous colitis, with marked thickening of the subepithelial layer, and Lymphocytic colitis. Multiple risk factors such as female gender, older age and celiac disease have been associated with this entity. A few studies have found an association between microscopic colitis and proton-pump inhibitor (PPI). 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Abstract

Background: •The study evaluated the risk of developing microscopic colitis and its subtypes in patients on PPI therapy.

Background: •Using a large multicenter database, a retrospective cohort analysis was conducted, excluding patients with autoimmune diseases, and adjusting for confounders.

Background: •An increased risk of developing microscopic colitis was associated with female gender, smoking, and the use of PPI, SSRI, and NSAIDs.

Background: •The use of PPI represented the highest odds of developing microscopic colitis.

Background: Microscopic colitis is a relatively new diagnosis that was first described in the 1980s. Patients usually present with chronic watery and non-bloody diarrhea and are typically characterized by an unremarkable gross appearance of the colon on lower endoscopy while having evidence of lymphocytic infiltration of the lamina propria and the epithelium on histology. Two subtypes have been described in the literature: Collagenous colitis, with marked thickening of the subepithelial layer, and Lymphocytic colitis. Multiple risk factors such as female gender, older age and celiac disease have been associated with this entity. A few studies have found an association between microscopic colitis and proton-pump inhibitor (PPI). The aim of our study was to evaluate the risk of developing microscopic colitis and its subtypes for patients who are on PPI therapy.

Methods: A validated multicenter and research platform database of more than 360 hospitals from 26 different healthcare systems across the United States from 1999 to September 2022 was utilized to construct this study. Patients aged 18 years and above were included. Individuals who have been diagnosed with any autoimmune disease have been excluded. A multivariate regression analysis was performed to assess risk of developing microscopic, lymphocytic, and collagenous colitis by accounting for potential confounders including female gender, smoking history, and the use of proton pump inhibitor, nonsteroidal anti-inflammatory drugs, and selective serotonin receptor inhibitors. A two-sided P value <0.05 was considered as statistically significant, and all statistical analyses were performed using R version 4.0.2 (R Foundation for Statistical Computing, Vienna, Austria, 2008).

Results: 78,256,749 individuals were screened in the database and 69,315,150 were selected in the final analysis after accounting for inclusion and exclusion criteria. The baseline characteristics of patients with microscopic, lymphocytic, and collagenous colitis is seen in table 1. Using a multivariate regression analysis, the risk of developing microscopic, lymphocytic, and collagenous colitis was calculated and illustrated in table 2.

Discussion: Our study showed that the risk of microscopic colitis, lymphocytic colitis and collagenous colitis was higher in females and smokers. Although medications like SSRI and NSAIDs showed a positive correlation with colitis, the highest likelihood of developing this disease was associated with PPIs. Lansoprazole has been documented to be associated with microscopic colitis as it is believed to inhibit colonic proton pumps, and subsequently promote diarrhea and inflammation. Interestingly, the prevalence of lymphocytic colitis and collagenous colitis was similar in the cohort of patients treated with PPIs, indicating no specific predisposition to either subtype. This study further confirms the risk factors associated with microscopic colitis. It can help guide physicians to recognize and eliminate these risk factors prior to initiating treatment for this disease. Future studies can focus on identifying the incidence of microscopic colitis with the different types of PPIs in the market.

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质子泵抑制剂与微小结肠炎风险增加有关:一项基于人群的研究和文献综述。
研究背景-该研究评估了PPI治疗患者罹患显微镜下结肠炎及其亚型的风险:-研究利用大型多中心数据库进行了一项回顾性队列分析,排除了自身免疫性疾病患者,并对混杂因素进行了调整:-微小结肠炎的发病风险增加与女性性别、吸烟以及使用PPI、SSRI和NSAIDs有关:-使用 PPI 代表了罹患显微镜下结肠炎的最高几率:显微镜下结肠炎是一种相对较新的诊断方法,最早出现在 20 世纪 80 年代。患者通常表现为慢性水样和非血性腹泻,典型特征是下部内镜下结肠外观无明显异常,但组织学检查显示固有层和上皮有淋巴细胞浸润。文献中描述了两种亚型:胶原性结肠炎(上皮下层明显增厚)和淋巴细胞性结肠炎。女性、高龄和乳糜泻等多种风险因素都与这种疾病有关。少数研究发现,显微镜下结肠炎与质子泵抑制剂(PPI)有关。我们的研究旨在评估正在接受质子泵抑制剂治疗的患者患显微镜下结肠炎的风险及其亚型:本研究采用了一个经过验证的多中心和研究平台数据库,该数据库涵盖了 1999 年至 2022 年 9 月期间美国 26 个不同医疗保健系统的 360 多家医院。研究对象包括 18 岁及以上的患者。已确诊患有任何自身免疫性疾病的患者不包括在内。通过考虑女性性别、吸烟史、使用质子泵抑制剂、非甾体抗炎药和选择性血清素受体抑制剂等潜在混杂因素,进行了多变量回归分析,以评估患显微镜下结肠炎、淋巴细胞性结肠炎和胶原性结肠炎的风险。双侧 P 值 结果数据库共筛选出 78,256,749 人,在考虑了纳入和排除标准后,最终分析选择了 69,315,150 人。显微镜下结肠炎、淋巴细胞性结肠炎和胶原性结肠炎患者的基线特征见表 1。通过多变量回归分析,计算出了患显微镜下结肠炎、淋巴细胞性结肠炎和胶原性结肠炎的风险,见表 2:我们的研究表明,女性和吸烟者患显微镜下结肠炎、淋巴细胞性结肠炎和胶原性结肠炎的风险较高。虽然 SSRI 和非甾体抗炎药(NSAIDs)等药物与结肠炎呈正相关,但 PPIs 的患病几率最高。兰索拉唑被认为会抑制结肠质子泵,进而促进腹泻和炎症,因此已被证实与微小结肠炎有关。有趣的是,在使用 PPIs 治疗的患者群中,淋巴细胞性结肠炎和胶原性结肠炎的发病率相似,这表明这两种亚型都没有特定的易感性。这项研究进一步证实了与微小结肠炎相关的风险因素。它有助于指导医生在开始治疗该疾病之前识别并消除这些风险因素。今后的研究可侧重于确定市场上不同类型的 PPIs 引起的显微镜下结肠炎的发病率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Arquivos de Gastroenterologia
Arquivos de Gastroenterologia Medicine-Gastroenterology
CiteScore
2.00
自引率
0.00%
发文量
109
审稿时长
9 weeks
期刊介绍: The journal Arquivos de Gastroenterologia (Archives of Gastroenterology), a quarterly journal, is the Official Publication of the Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia IBEPEGE (Brazilian Institute for Studies and Research in Gastroenterology), Colégio Brasileiro de Cirurgia Digestiva - CBCD (Brazilian College of Digestive Surgery) and of the Sociedade Brasileira de Motilidade Digestiva - SBMD (Brazilian Digestive Motility Society). It is dedicated to the publishing of scientific papers by national and foreign researchers who are in agreement with the aim of the journal as well as with its editorial policies.
期刊最新文献
GOOD CORRELATION BETWEEN LIVER STIFFNESS MEASUREMENT AND APRI, FIB-4, PLATELET COUNT, IN PEDIATRIC AUTOIMMUNE HEPATITIS. III BRAZILIAN CONSENSUS STATEMENT ON ENDOSCOPIC ULTRASOUND. PROTON-PUMP INHIBITORS ARE ASSOCIATED WITH AN INCREASED RISK OF MICROSCOPIC COLITIS: A POPULATION-BASED STUDY AND REVIEW OF THE LITERATURE. RE-THINKING FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING FOR CLINICAL DECISION-MAKING IN OROPHARYNGEAL DYSPHAGIA: AN EXPERT OPINION. ROBOTIC RESECTION OF A GIANT GASTROINTESTINAL STROMAL TUMOR (GIST): A PATH WE DARED TO TAKE.
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