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P125. The effect of suppressing gastric acid secretion in Crohn's disease

Y.M. Han1, S.J. Koh2, J.W. Kim2, J.P. Im1, J.S. Kim1, 1Seoul National University College of Medicine, Department of Internal Medicine and Liver Research Institute, Seoul, Korea, Republic of, 2Seoul National University College of Medicine, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Korea, Republic of

Background

A decrease in gastric acidity caused by proton pump inhibitors (PPIs) may induce changes in the normal intestinal flora, which may aggravate the prognosis of Crohn's disease (CD). The aim of the present study was to evaluate the effects of PPIs on the clinical course of CD.

Methods

All CD patients followed up at Seoul National University Hospital between 2005 and 2013 who were treated with PPIs were matched 1:2 to PPI-naive CD patients. The incidence rates of severe flare-up (operation or hospitalization) and mild flare-up (medication change) during a 6-month follow-up period were evaluated.

Results

No differences in age, sex, disease duration, associated diseases, or anal involvement were observed between the 38 patients treated with PPIs and the 76 control subjects. In the group exposed to PPIs, more patients had ileal involvement and history of prior hospitalization or operation. Concurrent treatment with azathioprine and 5-amino-salicylates was more prevalent in the control group, whereas changes in medication during the 6-month covariate assessment period were significantly more frequent in the group exposed to PPIs. However, after adjusting these confounding factors using multivariate binary logistic regression, the PPI use in the CD patients significantly increased the risk of severe flare-up (odds ratio, 6.896; 95% confidence interval, 1.110–42.850) and mild flare-up (odds ratio, 14.658; 95% confidence interval, 3.377–63.628).

Conclusion

The use of PPIs to suppress gastric acid secretion may be associated with poor prognosis in CD. Medical practitioners should pay special attention when prescribing gastric acid-suppressing agents for CD patients.