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PPIs linked with increased cholangitis risk
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Patients who used proton pump inhibitors were at higher risk for developing cholangitis, according to study results.
Juhee Cho, PhD, of the department of clinical research design and evaluation at Sungyunkwan University in South Korea, and colleagues wrote that PPIs reduce gastric acids, which could enable enteric infections like the ones that cause cholangitis. However, the association between PPIs and cholangitis has not been studied.
“While choledocholithiasis is the most common cause of cholangitis, bacterial infection and colonization of the biliary duct due to biliary obstruction are important mechanisms of cholangitis,” they wrote. “Specifically, retrograde infection of the biliary tract by gut bacteria leads to bacterial proliferation in biliary stasis with local disequilibrium of microbial populations and biliary inflammation.”
Researchers performed a cohort study using a nationwide representative sample of the South Korean population who were followed for up to 10 years. They identified PPI use using treatment claims and incident cholangitis from hospitalization and out-patient visit claims.
Over more than 4 million person-years of follow-up, researchers identified 58,826 individuals who had at least one PPI prescription, and of those individuals, 1,834 developed cholangitis.
After adjusting for age, sex, residential area and income, researchers found that PPI use was associated with cholangitis (adjusted HR = 6.06; 95% CI, 4.64–7.91). The association remained in a fully adjusted model (aHR = 5.75–7.54). The risk was highest during PPI use and decreased over time after discontinuation.
Cho and colleagues wrote that it is possible that PPI-induced increases of certain bacteria inside the biliary microbiota could be the cause of this increased risk for cholangitis.
“Although PPIs are effective for patients with acid-related disorders, physicians need to consider restricting long-term PPIs in individuals at high risk for cholangitis,” they wrote. “In addition, additional research is needed to clarify the mechanisms underlying the association between PPIs and cholangitis.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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