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Acid Suppression and Antibiotics Administered during Infancy Are Associated with Celiac Disease

Michael Boechler1, Apryl Susi2, Elizabeth Hisle-Gorman3

  • 1Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD.

The Journal of Pediatrics
|October 20, 2022
PubMed

Insights

Early life prescriptions for antibiotics, proton pump inhibitors (PPIs), and histamine-2 receptor antagonists (H2RAs) are linked to a higher risk of childhood celiac disease (CD). Medication stewardship may help reduce this risk.

Area of Science:

  • Pediatric Gastroenterology
  • Clinical Pharmacology

Background:

  • Celiac disease (CD) affects genetically susceptible individuals.
  • Understanding early life factors influencing CD development is crucial.

Purpose of the Study:

  • To investigate the association between early-life prescriptions of proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), and antibiotics and the subsequent diagnosis of celiac disease in children.

Main Methods:

  • Retrospective cohort study utilizing the Military Healthcare System database.
  • Analysis of outpatient prescription records for antibiotics, PPIs, and H2RAs within the first six months of life.
  • Cox proportional hazards regression to determine hazard ratios (HR) for CD development based on medication exposure.

Main Results:

  • A cohort of 968,524 children was analyzed, with 1704 diagnosed with CD.
  • Prescription of PPIs (HR, 2.23) and H2RAs (HR, 1.94) in early life was associated with a significantly increased hazard of CD.
  • Antibiotic prescriptions (HR, 1.14) were also linked to a higher hazard of developing CD.

Conclusions:

  • Early-life exposure to antibiotics, PPIs, and H2RAs increases the risk of developing celiac disease in childhood.
  • Medication stewardship represents a potential modifiable factor to alter the risk trajectory for childhood CD.
Abstract

Keywords:
age of onsetceliac disease epidemiologydietenvironmental exposureglutenrisk factorszonulin

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