M Boechler et al. J Pediatr 2023; 254: 61-67. Acid Suppression and Antibiotics Administered during Infancy Are Associated with Celiac Disease
Methods: A retrospective cohort study was performed using the Military Healthcare System database. N=968,524 children with 1704 cases of celiac disease (CD) in this group (from 2001 to 2013) with prescription for PPIs, H2RAs or antibiotics in first 6 months of life.
- PPIs (HR, 2.23; 95% CI, 1.76-2.83), H2RAs (HR, 1.94; 95% CI, 1.67-2.26), and antibiotics (HR, 1.14; 95% CI, 1.02-1.28) were all associated with an increased hazard of CD.
- The risk is increased by use of multiple categories of these medications and/or if acid suppression medications are used for longer periods
There have been previous studies indicating an increased risk of CD in patients given acid suppression (Lebwohl et al. Dig Liver Dis 2014; 46: 36-40) and conflicting data regarding the use of antibiotics. With regard to acid suppression, recent studies have indicated that these medications in infancy may increase the risk of food allergies as well. The authors speculate in their discussion that the increased risk for CD could be related to changes in protein degradation, mucosal permeability, microbiome changes, and immune reactivity. The authors note that their dataset did NOT show an increased risk of CD associated with C-section delivery.
One of the limitations of this study is that early presentations of CD could lead to prescriptions of agents to to help reduce symptoms rather than the medications increasing the risk of developing CD. However, this is unlikely as gluten introduction is often later in infancy.
My take: Better stewardship of antibiotics and acid blockers is needed. Use of acid suppression medications is associated with an increased risk of celiac disease as well as food allergies.
Related blog posts:
- First Year of Life Antibiotics and Celiac Disease
- Origins of Hygiene Hypothesis
- Do Acid Blockers Given to Infants Increase the Risk of Allergic Disease?
Additional posts on Celiac Disease
- Northern Latitudes -Higher Celiac Disease Prevalence
- Dietary Patterns in First Year of Life May Increase Celiac Autoimmunity
- Global Prevalence of Celiac Disease ~1.4%
- Celiac Disease Epidemic (High rate of celiac disease reported in Denver children)
- Vaccine for Celiac Disease
- Celiac Disease Risk –TEDDY study
- Celiac Disease and Mode of Delivery -Perhaps Not Very Consequential
- Celiac disease and diabetes
- How Birth Can Affect Your GI Tract | gutsandgrowth
- How to Protect Children From Celiac Disease
- Why are we seeing so many more cases | gutsandgrowth
- Why is Celiac Disease Becoming More Prevalent?