The study finds a potential link between infantile acid suppressors and celiac disease

Research led by the University of Tel Aviv has shown that infants prescribed acid suppressive drugs during their first six months of life had an increased risk of developing the autoimmunity of celiac disease under certain conditions of study.

The associations were present in a cohort study of more than 79,000 children, but did not appear in a separate case-test. The results do not answer questions to find out if an observable relationship exists.

The infantile use of acidic suppressive therapy, including proton pump inhibitors and histamine-2 receptor antagonists, such as omeprazole (Prilosec) and Ranitidine (Zantac), has increased in the world in recent years. Observation studies have found an association between the early use of these drugs and long -term side effects, including fractures and celiac disease.

Celiac disease is an immune mediation enteropathy in which an aberrant immune response to gluten damages the mucosa with small intestinal, leading to increased mucous permeability and chronic immune activation. Prevalence and incidence have increased in most countries in recent decades, both for HIV -positive celiac disease and celiac disease confirmed by biopsy.

Known mechanisms suggest that acid suppressive therapy could contribute to celiac disease by disturbing protein digestion and modifying the intestinal microbiota.

In the study, “early exposure to acidic suppressive therapy and the development of the self-immunity of celiac disease”, published in Jama Network OpenResearchers have carried out retrospective analyzes using population data to assess the association between the early use of acid suppressive treatment and the risk of autoimmunity of celiac disease.

The researchers used two retrospective observation conceptions: a paired cohort study and a case-control design with a negative test. The two analyzes were based on data at the population of Maccabi Healthcare Services, which covers more than a quarter of the Israeli population. The data was taken from children born between 2005 and 2020 who remained registered in the system in the first six months of life.

A total of 79,820 children were included in the paired cohort study. Among these, 19,955 had used acid suppressive therapy, omeprazole (Prilosec) or Ranitidine (Zantac), in the first six months after birth. Each exposed child was twinned with up to three unpresentation children. Follow-up continued until the age of 10, the child’s outing of the health system or the diagnosis of self-immunity from celiac disease.

In the cohort study, 1.6% of children who used acidic suppressive therapy developed the self-immunity from celiac disease, against 1.0% of those who did not do so. Acid suppressive therapy users had an adjusted risk ratio of 1.52 to develop the condition. A stronger association has been observed in children who used acid suppressive therapy for more than a month. The adjusted risk ratio for prolonged use was 1.65.

The researchers also analyzed the data from a case-control group of 24,684 children who had been tested for the self-immunity of celiac disease. Among those who were tested positive, 5.0% had used acid suppressive therapy. Among those who were tested negative, 4.6% used the medication. The rating report adjusted for this group was 1.07, which was not statistically significant.

In the cohort study, the suppressive treatment for acid was significantly associated with the self-immunity of celiac disease. On the other hand, no significant association has been observed in the test-to-test control analysis.

Although the authors note that the design of the cohort may have reflected the residual confusion associated with the probability of being tested, they could not confirm it. The results highlight the complexity of drawing conclusions based on observation data alone.

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