Influence of proton pump inhibitor use on clinical outcomes of patients with inflammatory bowel disease

Figures & data

Figure 1. Patient identification from the MarketScan Claims Database. Flowchart of patient identification.

Table 1. Baseline characteristics of IBD patients with and without concurrent PPI therapy.

	All Patients
	Total	No PPI	With PPI	p-value
	N = 46,234	N = 39,746	N = 6,488
Age, mean (SD), years	44.4 (12.8)	43.9 (12.9)	47.5 (11.9)	<0.001
Sex Female, n (%)	24813 (54%)	21,075 (53%)	3738 (58%)	<0.001
Crohn’s disease, n (%)	22,105 (48%)	18,541 (47%)	3564 (55%)	<0.001
Smokers, n (%)	2717 (6%)	2153 (5%)	564 (9%)	<0.001
HTN, n (%)	13,517 (29%)	10,618 (27%)	2899 (45%)	<0.001
Congestive heart failure, n (%)	452 (1%)	308 (1%)	144 (2%)	<0.001
Chronic kidney disease, n (%)	1158 (3%)	868 (2%)	290 (4%)	<0.001
Obesity, n (%)	7114 (15%)	5643 (14%)	1471 (23%)	<0.001
Diabetes, n (%)	4556 (10%)	3529 (9%)	1027 (16%)	<0.001
Chronic obstructive pulmonary disease, n (%)	998 (2%)	690 (2%)	308 (5%)	<0.001
Dementia, n (%)	27 (0%)	16 (0%)	11 (0%)	<0.001
Gastroesophageal reflux disease, n (%)	12,008 (26%)	7697 (19%)	4311 (66%)	<0.001
Esophagitis, n (%)	1832 (4%)	1151 (3%)	681 (10%)	<0.001
Gastritis, n (%)	6041 (13%)	4057 (10%)	1984 (31%)	<0.001
Gastric ulcer, n (%)	652 (1%)	408 (1%)	244 (4%)	<0.001
Duodenal ulcer, n (%)	328 (1%)	212 (1%)	116 (2%)	<0.001
Helicobacter pylori, n (%)	323 (1%)	208 (1%)	115 (2%)	<0.001
Immunomodulator use, n (%)	4128 (9%)	3611 (9%)	517 (8%)	0.003
Glucocorticoid use, n (%)	5091 (11%)	4075 (10%)	1016 (16%)	<0.001
PPI # of prescription, mean (SD)	0.6 (2.0)	0.0 (0.0)	4.4 (3.4)	<0.001
New biologic prescription, n (%)	9685 (21%)	8232 (21%)	1453 (22%)	0.002
IBD admission, n (%)	2174 (5%)	1668 (4%)	506 (8%)	<0.001
Surgery, n (%)	1155 (2%)	923 (2%)	232 (4%)	<0.001

Table 2. Propensity score-matched analysis: characteristics of IBD patients with and without concurrent PPI therapy.

	Total	No PPI	With PPI
	N = 10,016	N = 6426	N = 3590	p-value
Age, mean (SD), years	46.6 (12.3)	46.5 (12.3)	46.6 (12.3)	0.83
Crohn’s disease, n (%)	5298 (52.9%)	3382 (52.6%)	1916 (53.4%)	0.48
Sex Female, n (%)	5805 (58%)	3729 (58%)	2076 (58%)	0.84
Smokers, n (%)	308 (3%)	184 (3%)	124 (3%)	0.10
HTN, n (%)	3492 (35%)	2209 (34%)	1283 (36%)	0.17
Congestive heart failure, n (%)	9 (0%)	5 (0%)	4 (0%)	0.59
Chronic kidney disease, n (%)	89 (1%)	53 (1%)	36 (1%)	0.36
Obesity, n (%)	1343 (13%)	827 (13%)	516 (14%)	0.034
Diabetes, n (%)	857 (9%)	527 (8%)	330 (9%)	0.089
Chronic obstructive pulmonary disease, n (%)	50 (0%)	27 (0%)	23 (1%)	0.13
Dementia, n (%)	0 (0%)	0 (0%)	0 (0%)
Gastroesophageal reflux disease, n (%)	5409 (54%)	3416 (53%)	1,993 (56%)	0.023
Esophagitis, n (%)	304 (3%)	167 (3%)	137 (4%)	<0.001
Gastritis, n (%)	1593 (16%)	962 (15%)	631 (18%)	<0.001
Gastric ulcer, n (%)	22 (0%)	11 (0%)	11 (0%)	0.17
Duodenal ulcer, n (%)	15 (0%)	8 (0%)	7 (0%)	0.38
Helicobacter pylori, n (%)	4 (0%)	2 (0%)	2 (0%)	0.55
Glucocorticoid use, n (%)	807 (8%)	489 (8%)	318 (9%)	0.028
Immunomodulator Use, n (%)	490 (5%)	307 (5%)	183 (5%)	0.48
PPI Prescription Count, mean (SD)	1.5 (2.8)	0.0 (0.0)	4.2 (3.3)	<0.001
New Biologic Start	2,176 (22%)	1,346 (21%)	830 (23%)	0.011
IBD Admissions	547 (5%)	266 (4%)	281 (8%)	<0.001
IBD Surgeries	279 (3%)	147 (2%)	132 (4%)	<0.001

Figure 2. Multivariate analyses of outcomes of IBD patients with and without concurrent PPI therapy. (A) Multivariate analysis of new biologic use. (B) Multivariate analysis of IBD-related admission. (C) Multivariate analysis of IBD-related surgery.

Table 3. Association between PPI prescription count and the risk of new biologic use, IBD- related admission, and IBD-related surgery.

	Univariate				Multivariate
	Odds ratio	95%CI		p-value	Odds ratio	95%CI		p-value
		Lower	Upper			Lower	Upper
New biologic use	1.02	1.00	1.03	0.006	1.03	1.02	1.04	<0.001
Admission	1.04	1.02	1.06	<0.001	1.04	1.02	1.06	<0.001
Surgery	1.02	0.99	1.05	0.20	NA

Data availability statement

The data that support the findings of this study are available from IBM Truven MarketScan Database. Restrictions apply to the availability of these data, which were used under license for this study. Data are available from the authors with the permission of IBM Truven MarketScan Database.