Long-lasting proton pump inhibitor (PPI) treatment in people with cystic fibrosis (CF) appears to be linked with a twofold increase in the risk of Pseudomonas aeruginosa infection and no observable evidence of nutritional status improvement, according to a new study published in the journal Digestive and Liver Disease. 

A retrospective matched cohort study was conducted on a well-balanced sample of 160 pediatric and adult patients with CF. The authors used nearest neighbor propensity score matching based on sex, year of birth, CFTR genotype, and pancreatic insufficiency to establish pairs of patients treated with PPIs for at least 3 months and those who never received PPIs. All participants were tested at baseline and follow-up points, after which the results were compared. 

To analyze the nutritional status and the risk of infections, the researchers primarily looked for the follow-up changes in body mass index (BMI) and positive nasopharyngeal aspirate or sputum cultures for P aeruginosa. They also considered the rates of hospitalizations and pulmonary exacerbations during the relevant timeframe. 

Upon data analysis, it was evident that no relevant BMI difference persisted between the 2 patient groups. However, the follow-up rates of positive P aeruginosa culture and the number of hospitalizations due to pulmonary exacerbations were significantly higher in PPI-treated patients. 

“The increased risk of (P aeruginosa) infection is particularly concerning since it is well established that (P aeruginosa) contributes significantly to respiratory morbidity and mortality in cystic fibrosis and is considered the main pathogen leading to deterioration of lung function, hospitalization and even death in these patients,” Zazzeron and colleagues noted.

Progressive lung disease as the hallmark of CF often couples with several gastrointestinal manifestations such as pancreatic insufficiency and gastroesophageal reflux disease. Physicians frequently prescribe PPIs to reduce gastrointestinal symptoms, yet the efficacy of these medications and potentially severe side effects in people with CF still lack robust scientific research. 

Reference

Zazzeron L, Alicandro G, Daccò V, et al. Effects of prolonged proton pump inhibitor treatment on nutritional status and respiratory infection risk in cystic fibrosis: a matched cohort study. Dig Liver Dis. 2022;S1590-8658(22)00694-6. doi:10.1016/j.dld.2022.09.005