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Effects of prolonged proton pump inhibitor treatment on nutritional status and respiratory infection risk in cystic fibrosis: A matched cohort study

Published:October 14, 2022DOI:https://doi.org/10.1016/j.dld.2022.09.005

      Abstract

      Background

      Evidence on the effectiveness of proton pump inhibitors (PPI) as adjuvant therapy to improve maldigestion in people with cystic fibrosis (pwCF) is limited and there is increasing concern on possible side effects.

      Methods

      We conducted a matched cohort study based on paediatric and adult pwCF who received PPI for ≥3 months. Treated patients were matched to a group of patients who never received PPI using a nearest neighbour propensity score matching based on sex, year of birth, CFTR genotype and pancreatic insufficiency.

      Results

      The study included 160 pwCF: 80 treated and 80 untreated patients. Over a median follow-up of 2 years, no significant differences in changes in BMI z-score were detected between groups (adjusted mean difference: 0.06, 95% CI: -0.17–0.30). At baseline 25% (n = 20) of the treated patients and 22.5% (n = 18) of the untreated patients had a positive culture for P. aeruginosa (Pa). At follow-up percentages of Pa positive cultures increased to 47.5% (n = 38) in the treated group and to 26.3% (n = 21) in the untreated group (adjusted mean difference: 23.1%, 95% CI: 10.8–35.3).

      Conclusions

      Prolonged PPI therapy should be used cautiously in pwCF since it may increase the risk of respiratory infection by Pa. In addition, such treatment does not seem to improve nutritional status.

      Keywords

      Abbreviations:

      BMIZ (Z-score of Body Mass Index), CFTR (Cystic Fibrosis Transmembrane Conductance Regulator), GERD (Gastroesophageal reflux disease), Pa (Pseudomonas aeruginosa), PERT (Pancreatic Enzyme Replacement Therapy), ppFEV1 (Forced Expiratory Volume in one second as percent of predicted), PPI (Proton Pump Inhibitors), pwCF (People with Cystic Fibrosis), SMD (Standardized Mean Difference)
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