Proton pump inhibitor therapy did not increase the prevalence of small-bowel injury: A propensity-matched analysis

Atsuo Yamada; Ryota Niikura; Koutarou Maki; Masanao Nakamura; Hirotsugu Watabe; Mitsuhiro Fujishiro; Shiro Oka; Shunji Fujimori; Atsushi Nakajima; Naoki Ohmiya; Takayuki Matsumoto; Shinji Tanaka; Kazuhiko Koike; Choitsu Sakamoto

doi:10.1371/journal.pone.0182586

Proton pump inhibitor therapy did not increase the prevalence of small-bowel injury: A propensity-matched analysis

PLoS One. 2017 Aug 3;12(8):e0182586. doi: 10.1371/journal.pone.0182586. eCollection 2017.

Authors

Affiliations

¹ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan.
³ Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
⁴ Wakamiya Watabe Clinic, Chiba, Japan.
⁵ Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan.
⁶ Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
⁷ Division of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
⁸ Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan.
⁹ Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.

Abstract

Background: Previous studies have reported that the suppression of acid secretion by using proton pump inhibitors (PPIs) results in dysbiosis of the small-bowel microbiota, leading to exacerbated small-bowel injuries, including erosions and ulcers. This study was designed to assess the association between PPI therapy and small-bowel lesions after adjustment for the differences in baseline characteristics between users and non-users of PPIs.

Methods: We retrospectively studied patients suspected to be suffering from small-bowel diseases, who underwent capsule endoscopy between 2010 and 2013. We used propensity matching to adjust for the differences in baseline characteristics between users and non-users of PPIs. The outcomes included the prevalence of small-bowel lesions: erosion, ulcer, angioectasia, varices, and tumor.

Results: We selected 327 patient pairs for analysis after propensity matching, and found no significant differences in the prevalence of small-bowel injuries, including erosions and ulcers, between users and non-users of PPIs. Two subgroup analyses of the effect of the type of PPI and the effect of PPI therapy in users and non-users of nonsteroidal anti-inflammatory drugs indicated no significant differences in the prevalence of small-bowel injuries in these two groups.

Conclusion: PPI therapy did not increase the prevalence of small-bowel injury, regardless of the type of PPI used and the use of nonsteroidal anti-inflammatory drugs.

MeSH terms

Abdominal Injuries / chemically induced
Abdominal Injuries / epidemiology*
Aged
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Capsule Endoscopy / methods*
Female
Humans
Intestine, Small / diagnostic imaging*
Intestine, Small / drug effects
Intestine, Small / injuries
Male
Prevalence
Propensity Score
Proton Pump Inhibitors / adverse effects*
Proton Pump Inhibitors / pharmacology
Retrospective Studies
Risk Factors

Substances

Anti-Inflammatory Agents, Non-Steroidal
Proton Pump Inhibitors

Grants and funding

This study was partly supported by the Ministry of Health, Labour and Welfare (H23-NI-045), and The Japanese Association for Capsule Endoscopy. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.