From the Guidelines
Proton pump inhibitors (PPIs) are not contraindicated for Crohn's disease, and may be used to treat mild oesophageal Crohn’s disease. According to the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults 1, PPIs can be used to treat mild oesophageal Crohn’s disease, with nutritional assessment and support being essential. The guidelines suggest that a short course of corticosteroids may be required if symptoms worsen, but early anti-TNF therapy should be considered for ongoing moderate to severe disease.
Key Points
- PPIs may be beneficial for patients with Crohn's disease experiencing upper gastrointestinal symptoms, gastroesophageal reflux, or peptic ulcer disease
- PPIs are not a treatment for Crohn's disease itself, which typically requires specific anti-inflammatory medications, immunosuppressants, or biologics to manage the underlying inflammatory bowel condition
- As with any medication, PPIs should be used at the lowest effective dose for the shortest duration necessary, as long-term use has been associated with certain risks including nutrient malabsorption, increased risk of infections, and bone density changes. The guidelines provide a weak recommendation with very low-quality evidence, but with a high agreement of 97.6% among experts 1.
From the Research
PPI Contraindication for Crohn's Disease
- There is no direct evidence to suggest that PPIs are contraindicated for Crohn's disease 2, 3, 4, 5, 6.
- However, a study published in 2021 found that regular use of PPIs was associated with an increased risk of inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis 2.
- The study found that regular PPI users had an increased risk of IBD compared to non-users, with a hazard ratio of 1.42 (95% CI, 1.22-1.65) 2.
- Another study published in 2012 discussed the adverse effects and risks associated with long-term PPI use, but did not specifically address Crohn's disease as a contraindication 3.
- Other studies have focused on the clinical pharmacology and efficacy of PPIs in treating acid-related disorders, but have not addressed their use in Crohn's disease 4, 5, 6.
Key Findings
- Regular PPI use may increase the risk of IBD, including Crohn's disease 2.
- PPIs are generally considered safe, but long-term use can be associated with adverse effects 3.
- The choice of PPI may depend on individual patient factors and clinical situations, but all PPIs are considered effective for treating acid-related disorders 4, 5, 6.