Association Between Proton Pump Inhibitors and the Risk of Intestinal Behçet Disease

Keita Murakami; Junya Arai; Sozaburo Ihara; Yoshihiro Hirata; Yumi Tsuchida; Hirofumi Shoda; Mayo Tsuboi; Ken Kurokawa; Nobumi Suzuki; Hiroto Kinoshita; Yoku Hayakawa; Keishi Fujio; Mitsuhiro Fujishiro

doi:10.3899/jrheum.2024-0442

Association Between Proton Pump Inhibitors and the Risk of Intestinal Behçet Disease

J Rheumatol. 2024 Dec 1;51(12):1193-1197. doi: 10.3899/jrheum.2024-0442.

Authors

Affiliations

¹ K. Murakami, MD, S. Ihara, MD, PhD, M. Tsuboi, MD, PhD, K. Kurokawa, MD, PhD, N. Suzuki, MD, PhD, H. Kinoshita, MD, PhD, Y. Hayakawa, MD, PhD, M. Fujishiro, MD, PhD, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo.
² J. Arai, MD, PhD, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, and Department of Gastroenterology, The Institute of Medical Science, Asahi Life Foundation.
³ K. Murakami, MD, S. Ihara, MD, PhD, M. Tsuboi, MD, PhD, K. Kurokawa, MD, PhD, N. Suzuki, MD, PhD, H. Kinoshita, MD, PhD, Y. Hayakawa, MD, PhD, M. Fujishiro, MD, PhD, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo; sozaburo.ihara@gmail.com.
⁴ Y. Hirata, MD, PhD, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, and Division of Advanced Genome Medicine, The Institute of Medical Science, The University of Tokyo.
⁵ Y. Tsuchida, MD, PhD, H. Shoda, MD, PhD, K. Fujio, MD, PhD, Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

PMID: 39089843
DOI: 10.3899/jrheum.2024-0442

Abstract

Objective: This study aimed to investigate the association between proton pump inhibitor (PPI) use and the incidence of intestinal Behçet disease (BD) in patients with BD.

Methods: A retrospective cohort study was conducted at The University of Tokyo Hospital, including patients with BD diagnosed between April 2005 and November 2023. Cox models and Kaplan-Meier analyses were used to evaluate hazard ratios (HRs) and cumulative incidence of intestinal BD, respectively. Secondary analyses were performed to assess the duration and dose-response relationship of PPI use.

Results: Among 194 patients with BD, 25.3% developed intestinal BD during a mean follow-up of 12 years. PPI users had a significantly higher incidence of intestinal BD compared to nonusers (adjusted HR 2.48, 95% CI 1.38-4.47, P = 0.002), with a confirmed duration/dose-dependent relationship. The cumulative incidence of intestinal BD was markedly elevated in PPI users (log-rank P < 0.001). The result was similar to that in the propensity score-matched cohort.

Conclusion: This study demonstrates a significant association between PPI use and increased incidence of intestinal BD in patients with BD. Caution in prescribing PPIs for patients with BD is warranted due to the potential risk of severe complications associated with intestinal BD.

Keywords: Behçet disease; intestinal diseases; proton pump inhibitors.

MeSH terms

Adult
Behcet Syndrome* / complications
Behcet Syndrome* / epidemiology
Female
Humans
Incidence
Intestinal Diseases / chemically induced
Intestinal Diseases / epidemiology
Male
Middle Aged
Proportional Hazards Models
Proton Pump Inhibitors* / adverse effects
Retrospective Studies

Substances

Proton Pump Inhibitors