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

• Published in: Digestive and liver disease Vol. 55; no. 3; pp. 360 - 365
• Main Authors: Zazzeron, Laura, Alicandro, Gianfranco, Daccò, Valeria, Lanfranchi, Chiara, Bulfamante, Anna, Sciarrabba, Calogero Sathya, Corti, Fabiola, Colombo, Carla
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.03.2023
• Subjects: Adult; Child; Cohort Studies; Cystic fibrosis; Cystic Fibrosis - genetics; Humans; Nutritional Status; Proton pump inhibitors; Proton Pump Inhibitors - therapeutic use; Respiratory infections; BMIZ; PPI; Cystic fibrosis; SMD; GERD; Pa; PERT; ppFEV1; Respiratory infections; Proton pump inhibitors; Nutritional status; CFTR; pwCF
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2022.09.005

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. 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. 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). 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.