Use of proton pump inhibitors and subsequent risk of celiac disease

  • Benjamin Lebwohl
    Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
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  • Stuart J. Spechler
    Division of Gastroenterology, Department of Internal Medicine, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, TX, USA
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  • Timothy C. Wang
    Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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  • Peter H.R. Green
    Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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  • Jonas F. Ludvigsson
    Corresponding author at: Department of Pediatrics, Örebro University Hospital, Sweden. Tel.: +46 019 6021000; fax: +46 019 187915.
    Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden

    Department of Pediatrics, Örebro University Hospital, Sweden
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Published:September 16, 2013DOI:



      The prevalence of celiac disease and the use of medications that inhibit acid secretion have both increased in recent decades.


      To explore the association between antisecretory medication exposure and subsequent development of celiac disease.


      In this population-based case control study, we identified patients with celiac disease diagnosed at all pathology departments in Sweden from July 2005 through February 2008. Patients were matched by age and gender with up to 5 controls. We identified prior prescriptions for proton pump inhibitors and histamine-2 receptor antagonists in all subjects. We used conditional logistic regression to measure the association between these prescriptions and the subsequent diagnosis of celiac disease.


      Prior proton pump inhibitor prescription was strongly associated with celiac disease (OR 4.79; 95% CI 4.17–5.51). Patients prescribed both proton pump inhibitors and histamine-2 receptor antagonists had a higher risk of celiac disease (OR 5.96; 95% CI 3.58–9.91) than those prescribed proton pump inhibitors alone (OR 4.91; 95% CI 4.26–5.66) or histamine-2 receptor antagonists alone (OR 4.16; 95% CI 2.89–5.99).


      Exposure to antisecretory medications is associated with a subsequent diagnosis of celiac disease. The persistence of this association after excluding prescriptions in the year preceding the celiac disease diagnosis suggests a causal relationship.


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