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    Do Proton Pump Inhibitors Increase Risk of Celiac Disease?

    Jefferson Adams
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    Reviewed and edited by a celiac disease expert.

    Celiac.com 10/30/2013 - Rates of celiac disease and the use of drugs to inhibit the secretion of stomach acid have both increased in recent decades. A research team recently set out to explore the association between anti-secretory medication exposure and subsequent development of celiac disease.

    Photo: CC--Keepingtime in CAThe research team included Benjamin Lebwohl, Stuart J. Spechler, Timothy C. Wang, Peter H.R. Green, and Jonas F. Ludvigsson. They are affiliated with the Celiac Disease Center at the Department of Medicine at Columbia University College of Physicians and Surgeons in New York, NY.



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    For their population-based case control study, the research team looked at data for celiac disease patients diagnosed at any of the pathology departments in Sweden from July 2005 through February 2008.

    They matched each patient by age and gender with up to 5 control subjects. They found prior prescriptions for proton pump inhibitors and histamine-2 receptor antagonists in all subjects.

    Using conditional logistic regression to measure the association between these prescriptions and the subsequent diagnosis of celiac disease, they also found that patients with proton pump inhibitor prescriptions were much more likely to have celiac disease (OR 4.79; 95% CI 4.17–5.51).

    Patients prescribed both proton pump inhibitors and histamine-2 receptor antagonists had an even higher risk for celiac disease (OR 5.96; 95% CI 3.58–9.91) than those who received 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).

    The data clearly show that patients who use anti-secretory medications are at much greater risk for developing celiac disease following the use of these medicines.

    The fact that this connection persisted even after the team excluded prescriptions for anti-secretory medicines in the year preceding the celiac disease diagnosis suggests a causal relationship.

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    I find this article and study very interesting. I have always had issues with gluten (since I was very little). But, I did not begin to have full-blown symptoms until after the introduction of proton-pump inhibitors after a bout with food poisoning rendered me useless away from a bathroom. :-p Since I always had issues with acid reflux as well, the doctors thought it necessary to put me on acid reflux meds. When that didn't work, they moved me to a proton pump inhibitor (Protonix). Although my acidic stomach did obtain some relief, I was still having issues whenever I ate wheat (then we realized any gluten was upsetting as well). Once I stopped all gluten, however, I no longer needed the proton pump inhibitor.

     

    Did this study determine if a certain brand of medications were involved as well?

     

    Thank you for sharing this information.

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    I found this very interesting, but wonder if most of the patients didn't have 'silent' coeliac, and that is why they needed the PPIs. Which then unmasked the full coeliac symptoms.

    Jenny, you have expressed my exact question as well. I wish the article had addressed this possibility.

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    I have had heartburn everyday since I was 15 years old. By the age of 25 I was drinking malox by the gallon. At 30 I was taking Tagamet every 4 to 5 hours. I switched to Priolosec at 35 years of age. As I look back I believe I started having symptoms of celiac at age of about 35 to 40. I was diagnosed and quit gluten at 52 years of age. I went back on gluten for 1 month at 58 and the symptom came back. I would like to point out that I read an article in Sci Am about 5 years ago from a researcher in Maryland. His hypothesis was that a high acidity environment in the small intestines brought on by excessive acid production the the stomach brought about celiac. If that is true then it is the condition (hyperacidity) that impels people to take proton pump inhibitors that actually causes the condition of celiac. To me that is a much more satisfying explanation that that the proton pump inhibitor itself is causing the condition.

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    I have had heartburn everyday since I was 15 years old. By the age of 25 I was drinking malox by the gallon. At 30 I was taking Tagamet every 4 to 5 hours. I switched to Priolosec at 35 years of age. As I look back I believe I started having symptoms of celiac at age of about 35 to 40. I was diagnosed and quit gluten at 52 years of age. I went back on gluten for 1 month at 58 and the symptom came back. I would like to point out that I read an article in Sci Am about 5 years ago from a researcher in Maryland. His hypothesis was that a high acidity environment in the small intestines brought on by excessive acid production the the stomach brought about celiac. If that is true then it is the condition (hyperacidity) that impels people to take proton pump inhibitors that actually causes the condition of celiac. To me that is a much more satisfying explanation that that the proton pump inhibitor itself is causing the condition.

    I have a tendency to agree with you, I have an ulcer, and do to the awful pain, the doctor said to take Nexium. I never had acid stomach problems before my ulcer 5 years ago. Now, my ulcer is back again, and I am having symptoms of celiac disease. I have an appointment with a specialist this time I am getting to the root of my ulcer, something the last doctor did not do. I also have low thyroid, or Hasimotos, which I have read on this website and others that can cause celiac, or be caused from celiac disease. I feel that the Hasimotos is my main problem, though, which has caused the ulcer, which now do to taking Nexium has caused my celiac disease. I just want to share this info for anyone who may be struggling like I have to find a cure.

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    I've been saying this for years. I did not have any symptoms of gluten intolerance until I was prescribed heavy doses of pepcid (at that time prescription only) which I took for several years. Then I developed a gluten intolerance. I've always thought the two were linked.

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    I wonder if the decreased acid production and acidity of the stomach acids, leads to less effective enzymatic breakdown of proteins thus somehow effecting how the bodies immune system reacts to proteins. This could potentially incerease the chance for food intolerance (enzyme break down issues), food sensitivites, and allergies as increased proteins and unbroken down food and protein chains showing up in a more complete state where they should not in the GI tract. All speculative on my part.
     

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,500 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.


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