Proton Pump Inhibitors Increase Risk of Celiac Disease

Very interesting.  I was prescribed a course of these for the first time a week or two in early 2013 after taking some medication that had upset my stomach (gastritis).   As soon as I started taking them, although it could have been a coincidence, I started getting severe diarrhea which never stopped.  After a few weeks my doctor ran some tests and discovered I was a coelaic.   At the time I wondered if the PPIs had caused coeliac disease.  But then I don't think so - it may have kicked off the diarrhea, but I'd had neurological symptoms a long time before that, with iron anemia, strange liver enzyme tests and clinical anxiety.   When I was diagnosed my TTG numbers were off the scale, and I don't think that happens in a few weeks?  Anyway, in a strange way, I feel taking a PPI was instrumental in finally bringing about my diagnosis.   I do occasionally take them now for gastritis-like symptoms when my home remedies need a little help. I get through about 30 a year and find they nip my symptoms in the bud so I'm grateful for them when used in this way.  I have read a lot of differing views on this medication over the years on this forum, it's all very interesting.  Thanks for posting, Jefferson.

What I got from this article is that they showed correlation, not causation. I don’t see how excluding prescriptions in the year preceding celiac diagnosis pointed to a causal connection. Besides, a lot of those drugs are available OTC, so were they counting those too, or just prescriptions? Regardless, I never had heartburn or took anything for acid reflux until years after I was diagnosed with celiac and maintaining a gluten-free diet. Color me skeptical. 

19 minutes ago, Guest Kristina said:

What I got from this article is that they showed correlation, not causation. I don’t see how excluding prescriptions in the year preceding celiac diagnosis pointed to a causal connection. Besides, a lot of those drugs are available OTC, so were they counting those too, or just prescriptions? Regardless, I never had heartburn or took anything for acid reflux until years after I was diagnosed with celiac and maintaining a gluten-free diet. Color me skeptical. 

I also do not comprehend the significance of "This association remained, even after the team excluded prescriptions in the year preceding the celiac disease diagnosis" with respect to the outcome of the study. I wish they had elaborated on that statement.

But what is the point of your statement to the effect that secretion blockers are available as OTC? Are you implying that nullifies the validity of the control group? I note that the study focused on those diagnosed with celaic disease between the years 2005-2008. I'm not sure which of these products were available OTC previous to that time period.

The correlation is interesting but it seems more confidence than possible.  Were any of these patients tested for celiac prior to being put on ppi medication?   Perhaps they were really showing early signs of celiac and went undiagnosed until intestinal damage symptomatic enough to test for it?

2 hours ago, Guest Jen said:

The correlation is interesting but it seems more confidence than possible.  Were any of these patients tested for celiac prior to being put on ppi medication?   Perhaps they were really showing early signs of celiac and went undiagnosed until intestinal damage symptomatic enough to test for it?

Yes, there are a lot of variables here that would be difficult or impossible to nail down.

59 minutes ago, Guest Jen said:

Were any of these patients tested for celiac prior to being put on ppi medication?

Thats why the one year exclusion. The ppi and histamine antagonist use preceded the diagonsis by at least a year to eliminate the group that took ppi's on the way to diagnosis.

So, a patient who presents with a past history of PPI and histamine antagonist use is more likely to be eventually diagnosed with Celiac than someone who only needed PPI or histomine antagonist.

PPI's cause higher Ph in the stomach, reducing the body's self defense against gluten which increases the quantity of gluten that survives the acid bath. The PPI solves the acid indigestion and the histomine antagonist works on the autoimmune effects.

In the study almost 6% of Celiacs had prior use of both. It would be interesting to see how many of those who used both were not diagnosed Celiac.

It is tricky because at least in cardiovascular disease they use "risk factor" and "cause" interchangebly to promote compliance with lipid and bp treatments.

37 minutes ago, Wheatwacked said:

Thats why the one year exclusion. The ppi and histamine antagonist use preceded the diagonsis by at least a year to eliminate the group that took ppi's on the way to diagnosis.

So, a patient who presents with a past history of PPI and histamine antagonist use is more likely to be eventually diagnosed with Celiac than someone who only needed PPI or histomine antagonist.

PPI's cause higher Ph in the stomach, reducing the body's self defense against gluten which increases the quantity of gluten that survives the acid bath. The PPI solves the acid indigestion and the histomine antagonist works on the autoimmune effects.

In the study almost 6% of Celiacs had prior use of both. It would be interesting to see how many of those who used both were not diagnosed Celiac.

It is tricky because at least in cardiovascular disease they use "risk factor" and "cause" interchangebly to promote compliance with lipid and bp treatments.

But the issue still remains that unless the study group were tested for celiac disease before beginning acid blocker use there is no way to know whether or not they had celiac disease before starting the med. I mean it is no secret that most celiacs go undiagnosed for years.

If 94% of diagnosed Celiacs were not given this combo, it can't be the cause, but it may be a symptom possibly even a good indicator to screen for Celiac at that point. Depends on how many had this treatment and did not go on to develope celiac disease.  Lowered stomach pH allows more gluten to survive past the stomach and may exacerbate the symptoms of indigestion (because it is celiac, not indigestion) requiring the addition of the histomine blocker to control it. Similar to what sufficient vitamin D does, I believe; modulate the response. So, history of PPI + histomine blockers = reason to screen for undiagnosed Celiac?

BTW Happy New Year. 💥

Why is this presented as a "recent"  study?  It was published nearly a decade ago --  September 2013, according to the link posted (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3947159/).  What has been learned since then?

 

I wish I could recall the study I saw some ~20 years back, but essentially it said that even though only 1% of the population has celiac disease, something like 15-20% of patients who had been seeing a gastroenterologist for more than 6 months had undiagnosed celiac disease. In other words, most people who visit a gastro doctor should simply be screened for celiac disease right when they walk in the door.

I realize there have been studies done on whether mass-screenings for celiac disease would be economically feasible, and some have shown that they would not be, however, mass-screening those who are referred to a gastroenterologist probably would be.

"In other words, most people who visit a gastro doctor should simply be screened for celiac disease right when they walk in the door."

Quite right @Scott Adams .   I can't understand why this isn't done.

Too many still believe it is a fad or psychosomatic.  That wheat is an essential food and we need to eat it for good health. 🤑 If a primary doctor is going to refer to a gastroenterologist why not run a Celiac blood panel first? It would save time and unnecessary suffering for the patient while waiting for an appointment only to wait more for a biopsy. That might be a question for the insurance companies.