The influence of proton pump inhibitor therapy on the outcome of infliximab therapy in inflammatory bowel disease: a patient-level meta-analysis of randomised controlled studies

Review (5 RCTs; n= 147 infliximab + PPI; n=889 infliximab) found after baseline adjustment, those taking PPI were less likely to achieve remission on (week 30 remission rates; 30% and 49%; p<0.001) and more likely to be hospitalised (15% vs 8%, p=0.007).

SPS commentary:

The authors suggest that inhibition of gastric acid with PPIs has been associated with an increased risk of infectious gastroenteritis which may lead to worsening of symptoms in patients with IBD. However, when they analysed gastroenteritis rates between patients with and without PPI exposure they found no statistically significant difference. Another proposed mechanism is PPIs may alter immune cell function and promote gut dysbiosis.

 

 

Overall, these results raise caution in prescribing a PPI to patients with IBD and require further prospective studies to validate these findings and explore potential underlying mechanisms.

Gut