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Association Between Proton Pump Inhibitors and Microscopic Colitis
Ernest H Law1, Melissa Badowski2, Yu-Ting Hung1
11 Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA.
Objective:
Microscopic colitis (MC) is a chronic inflammatory disease of the colon that is characterized by chronic, watery, nonbloody diarrhea. Concern regarding a potential association between proton-pump inhibitors (PPIs) and MC has recently emerged. We sought to systematically review and summarize the evidence for the potential association between PPIs and MC.
Data Sources:
We systematically searched EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, International Pharmaceutical Abstracts, and Google Scholar using the terms proton-pump inhibitors (omeprazole, lansoprazole, dexlansoprazole, rabeprazole, pantoprazole, or esomeprazole), microscopic colitis, collagenous colitis, and lymphocytic colitis.
Study Selection:
Full-text, English-language reports of case reports/series, observational studies, experimental studies, and systematic reviews/meta-analyses published between January 2000 to August 2016 were included. Bibliographies from pertinent publications were reviewed for additional references. Outcome was defined as the development of biopsy-confirmed MC.
Data Extraction/Synthesis:
A total of 19 publications were identified: 5 case control studies and 14 case reports/series (encompassing a total of 32 cases). All studies were limited by small sample sizes. Risk of MC by dose or specific PPI agent was not investigated in any of the studies. A review of the current body of evidence reveals a possible association between PPIs and MC.
Conclusions:
There is a need for large observational studies of high quality to examine the differential effect of specific PPIs and whether the magnitude of association is dose dependent. Given their widespread use, clinicians should routinely question whether patients are receiving unnecessary treatment with PPIs and discontinue therapy where appropriate.
Insights
Proton-pump inhibitors (PPIs) may be associated with microscopic colitis (MC), a chronic diarrheal condition. Further research is needed to confirm this link and guide clinical practice regarding PPI use.
Area of Science:
- Gastroenterology
- Pharmacology
- Clinical Medicine
Background:
- Microscopic colitis (MC) is a chronic inflammatory colon condition causing watery diarrhea.
- Emerging concerns suggest a potential link between proton-pump inhibitors (PPIs) and MC development.
Purpose of the Study:
- To systematically review and synthesize existing evidence on the association between PPI use and microscopic colitis.
Main Methods:
- Searched multiple databases (EMBASE, MEDLINE, etc.) for studies published between 2000-2016.
- Included case reports/series, observational studies, and reviews focusing on biopsy-confirmed MC.
- Identified 19 relevant publications, including 5 case-control studies and 14 case reports/series.
Main Results:
- The reviewed evidence suggests a possible association between PPI use and microscopic colitis.
- All included studies had small sample sizes, limiting definitive conclusions.
- No studies investigated dose-dependency or specific PPI agent risks.
Conclusions:
- High-quality observational studies are needed to clarify the PPI-MC relationship, including dose effects.
- Clinicians should assess the necessity of PPI therapy and consider discontinuation when appropriate due to widespread PPI use.
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