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  • Scott Adams
    Scott Adams

    Aspirin (NSAIDs) and Acid Suppression Drugs (PPIs) Associated with Seronegative Celiac Disease

    Reviewed and edited by a celiac disease expert.

    Researchers are calling for more study after acid suppression drugs are tied to seronegative celiac disease.

    Aspirin (NSAIDs) and Acid Suppression Drugs (PPIs) Associated with Seronegative Celiac Disease - Image: CC BY 2.0--Dirk Vorderstraße
    Caption: Image: CC BY 2.0--Dirk Vorderstraße

    02/17/2021 - Celiac disease rates in the US have increased in past decades, along with the use of proton pump inhibitors (PPIs), histamine-2-receptor antagonists (H2RAs), aspirin (ASA) and nonsteroidal anti-inflammatory drugs (NSAIDs). Is there any important connection between celiac rates and the use of these drugs?

    A team of researchers recently set out to measure the association between medication use and distribution of villous flattening among patients with newly diagnosed celiac disease.

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    The research team included Robyn Jordan, Sarah Shannahan, Suzanne K Lewis, Suneeta Krishnareddy, Daniel A Leffler, Peter H R Green, and Benjamin Lebwohl.

    They are variously affiliated with the Icahn School of Medicine at Mount Sinai, United States; the Celiac Center, Beth Israel Deaconess Medical Center, United States; the Celiac Disease Center, Department of Medicine, Columbia University Medical Center, United States; the Celiac Disease Center, Department of Medicine, Columbia University Medical Center, United States; and the Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, United States. 

    The research team conducted a cross-sectional study of newly-diagnosed adult celiac patients at two institutions. They gathered data on regular use of these medications, clinical presentation, celiac disease serologic status, and distribution of villous flattening. 

    They then compared current ASA/NSAID users against non-users, and current PPI/H2RA users to non-users, with regard to these clinical characteristics.

    Of 148 patients with newly-diagnosed celiac disease, current users of ASA/NSAIDs and PPI/H2RAs were about 8 or 9 years older than non-users. Just 12% of seropositive patients used PPI/H2RAs, compared to 55% of seronegative patients. 

    Users of PPI/H2RA or ASA/NSAID showed no differences in villous flattening in the bulb and distal duodenum. However, the data show that PPI/H2RA use was associated with seronegative celiac disease. 

    The researches are calling for further assessment on the impact of these drugs on the development, presentation, and course of celiac disease.

    Read more in Digestive Liver Disease. 2017 Aug;49(8):883-886.

    Edited by Scott Adams



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    pokey449

    Yes I had a biopsy which showed mild villi blunting. Blood tests for celiac were negative. I’ve been on a gluten free diet for 6 months with the possible exception that the oatmeal I had been eating might have been contaminated ( I didn’t know oatmeal could get contaminated) and I switched to certified gluten free oatmeal 3weeks ago. Not much difference in symptoms. I think it’s GERD coming back or perhaps the SIBO is back or the SIBO causing Gerd or whatever. It seems all these wretched conditions exacerbate each other. Ijust know I feel lousy and can’t figure out a solution. 

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    pokey449

    Question. I’ve read in numerous places that SIBO can cause GERD. The thing is I had GERD long before ever having SIBO so I’m not inclined to believe that theory. I do believe PPIs can cause SIBO. Can PPIs and SIBO cause celiac?? 

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    Posterboy
    17 hours ago, pokey449 said:

    Yes I had a biopsy which showed mild villi blunting. Blood tests for celiac were negative. I’ve been on a gluten free diet for 6 months with the possible exception that the oatmeal I had been eating might have been contaminated ( I didn’t know oatmeal could get contaminated) and I switched to certified gluten free oatmeal 3weeks ago. Not much difference in symptoms. I think it’s GERD coming back or perhaps the SIBO is back or the SIBO causing Gerd or whatever. It seems all these wretched conditions exacerbate each other. Ijust know I feel lousy and can’t figure out a solution. 

     

    17 hours ago, pokey449 said:

    Question. I’ve read in numerous places that SIBO can cause GERD. The thing is I had GERD long before ever having SIBO so I’m not inclined to believe that theory. I do believe PPIs can cause SIBO. Can PPIs and SIBO cause celiac?? 

    Pokey,

    The nausea can come from a Vagus Nerve disorder....triggered by Low Thiamine levels....

    Open Original Shared Link

    Stress can trigger heartburn......because it depletes our stomach acid...

    Taking PPI's locks you into a viscous cycle...

    See/read about this link about stress being the trigger for heartburn...

    Entitled "The effect of life stress on symptoms of heartburn/GERD"

    Open Original Shared Link

    I also wrote a Posterboy Blog post called an "Open Letter to Celiac's and other GI Sufferer's that might help you...

    Entitled "Open Letter Part 1 to Fellow GI Sufferers etc. Like IBS, UC, and other GI diseases like Infant Heartburn (GERD) that grows into (in time) to IBS, UC, Chron's and NCGS as a teenager or Celiac disease in time as an adult - Look beyond to the Parent disease"

    Lord willing you will find  it helpful....

    I used to try and "over explain" these things.....and why I wrote my Posterboy blog posts in the first place......because I don't have the time to explain them now or anymore...

    Here is the link to my many Posterboy Blog post(s).....maybe you will find at least one of them helpful to you!

    I have used up my time for now but I hope you find at least one helpful....read as many as you need to help you understand...

    I have been you and got better from heartburn (GERD), constipation, diarrhea, IBS, nausea etc...

    I found MORE stomach acid not Less Stomach Acid helped me!

    2 Timothy 2:7 “Consider what I say; and the Lord give thee understanding in all things” this included.

    Posterboy by the Grace of God,

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    pokey449

    Posterboy; I don't think I have a thiamine deficiency as I am taking extra B12, D3, Multi-vit, Mg Citrate, digestive enzymes, tumeric/ginger, Lactobacillus, DGL and Apple cider vinegar and aloe vera when I can remember to drink it. I did fine for a while after getting completely off the PPI but gradually the nausea kept getting worse and worse. It gets so bad it keeps me awake much of the night. I understand the argument about more acid versus less but don't know if I can do it as I get to feeling so bad. So far the supplements aren't cutting it. Thinking I may have to reinstate on the PPI and then do another slow taper again, supplementing  as I go. I didn't do any supplementing when I tapered the PPI the first time. That said thank you for the advice and the links. I will check them out.

    Pokey

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    Posterboy

    Pokey,

    Try the Benfotiamine form or (another Fat Souble form like Allithiamine or Lipothiamine (both much harder to find and  why I recommended the Benfotiamine form)) because they have much better absorption rates.....the Thiamine in most B-complex's have low Bio-availability...

    I think you are following this thread but go back and read my Posterboy comments about the higher absorption rates for Benfotiamine.

    https://www.celiac.com/forums/topic/154653-how-long-does-it-take-to-feel-well/ 

    Here is the best article I have ever read on Thiamine and its role in Autoimmune disease....

    I hope it helps you!

    https://awaken.com/2021/02/the-overlooked-vitamin-that-improves-autoimmune-disease-and-autonomic-dysfunction/

    But you won't do what you don't believe!

    Other's have shown improvement after taking Benfotiamine when they didn't feel better after taking a B-Complex....which typically only has 5 percent absorptivity of the typical thiamine form of the supplement in them....and why people can take them and not feel any better.....thinking they are doing everything right....but showing no improvement....

    I hope this is helpful but it is not medical advice.

    Posterboy,

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    pokey449
    25 minutes ago, Posterboy said:

    Pokey,

    Try the Benfotiamine form or (another Fat Souble form like Allithiamine or Lipothiamine (both much harder to find and  why I recommended the Benfotiamine form)) because they have much better absorption rates.....the Thiamine in most B-complex's have low Bio-availability...

    I think you are following this thread but go back and read my Posterboy comments about the higher absorption rates for Benfotiamine.

    https://www.celiac.com/forums/topic/154653-how-long-does-it-take-to-feel-well/

    Here is the best article I have ever read on Thiamine and its role in Autoimmune disease....

    I hope it helps you!

    Open Original Shared Link

    But you won't do what you don't believe!

    Other's have shown improvement after taking Benfotiamine when they didn't feel better after taking a B-Complex....which typically only has 5 percent absorptivity of the typical thiamine form of the supplement in them....and why people can take them and not feel any better.....thinking they are doing everything right....but showing no improvement....

    I hope this is helpful but it is not medical advice.

    Posterboy,

    So Benfotiamine is Thiamine??

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    pokey449

    Thanks. I ordered some Befotiamine and a really good Multivitamin as well. I’m taking a number of other supplements as well. 

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    Guest ANTHONY COLATRELLA

    Posted

    On 2/27/2021 at 4:22 PM, pokey449 said:

    I was put on PPIs back in 2003 when I had H pylori and esophagitis (GERD). Nausea at the time was not an issue. I was kept of PPIs for the GERD and gastritis which became less of an issue with time. They kept me on the PPI for 17 years because supposedly "I needed it" per my docs to prevent getting Barretts. Fast forward to early summer 2020 when I was diagnosed with SIBO. I started having nausea before that diagnosis. After I learned PPI cause SIBO I tapered off the PPI. The SIBO was treated successfully wit Xifaxan, but the nausea remains. My current GI doc thinks the nausea is from to much acid, yet he says any acid rebound from getting off the PPI should have ended soon after getting off the PPI. SO, I don't know what's causing the nausea for sure. To much acid, not enough? Has the SIBO come back?? Its all one big mystery to me. I just know I'm sick n tired of it. That said I tend to think the PPI caused the SIBO which caused the villi blunting as you suggest. Im not convinced I am celiac as no one in my family is and I think it would have shown up ,ong before now, I am 72. 

    SIBO is difficult to treat---not generally eradicated with one course of treatment---often takes intermittent treatment although you are off the PPIs which should have helped preventing a recurrence but might be worth rechecking for the SIBO---I would doubt acid is playing a role--another possibility is gastroparesis which can certainly cause nausea and cold be an underlying factor in your esophagitis and the SIBO-( it could involve SB also)--could discuss with your MD checking for that and was your H.pylori treated and proven to be eradicated?

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    pokey449

    The Xifaxan was my 2nd round of antibiotic. I was breath tested after the Xifaxan and had normal H2 levels. SIBO gone. Bloating and cramping and mega gas gone as well. I don’t think the SIBO is back.  Recently had biopsy for H pylori which was negative. Nausea and burning gnawing sensation is what keeps coming back. A dose of famotidine relieves it for a while and then it’s back. My naturopath thinks it’s gastritis due to to much acid. Wants me back on PPI for a month plus a bunch of supplements and then taper off the PPI again slowly using a compounded liquid form of the PPI. Confirming that approach with my GI doc today. 

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    Scott Adams

    Antibiotics can be very rough on your system. I hope you are taking lots of probiotics.

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    Wheatwacked
    Quote

     Fermented vegetables like “pickles” and sauerkraut were traditionally fermented in brine by covering with water, adding salt, and leaving at room temperature for several days, or longer, until they were bubbling with proliferating bacteria that fed on the naturally occurring sugar in the vegetables...Typically, commercially pickled items like sauerkraut and cucumber pickles are pickled with vinegar. While the vinegar is fermented, the vegetables have not been fermented. So, the probiotics contained in the jar will primarily be from the vinegar. If the vegetables were fermented the traditional way using water and salt, they would create a wider variety of bacteria than what is contained in the vinegar. Vinegar will also kill a lot of other bacteria, both good and bad bacteria. This makes it good for preserving food because it prevents bad bacteria from growing which would spoil the food. However, when you add vinegar to fermented foods, it destroys much of the good bacteria also. While pickled foods offer some probiotic benefit, it is best to eat a variety of traditionally fermented foods to increase the variety of good bacteria in your gut microbiome....Recent studies of Amazonian hunter-gatherer tribes, like the Matses and Yanomami, have found a much richer biodiversity in their gut microbiome than is found in the guts of Americans. Not only do the Amazonian’s digestive tracts have 50% more bacteria, they have dozens of strains of bacteria, some of them associated with anti-inflammatory activity, that are completely absent in the microbiome of American’s. This is likely due to the amount of processed food in the typical American diet versus the fresh, natural food consumed in the Amazon rainforest. Processed food is often refined and heated at high temperatures, making it void of bacteria as well as much of the original nutrition. Fresh food on the other hand, is brimming with naturally occurring bacteria. Fresh vegetables and fruit also contain fiber that is woefully lacking in processed food. Open Original Shared Link

    Try making your own pickles. It only takes three to five days. There must be a reason jokes about pregnant women craving pickles and ice cream were so popular.

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  • About Me

    Scott Adams

    Scott Adams was diagnosed with celiac disease in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. In 1995 he launched the site that later became Celiac.com to help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives.  He is co-author of the book Cereal Killers, and founder and publisher of the (formerly paper) newsletter Journal of Gluten Sensitivity. In 1998 he founded The Gluten-Free Mall which he sold in 2014. Celiac.com does not sell any products, and is 100% advertiser supported.


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