Certain medications used to treat acid reflux are associated with an increased risk of hospitalization in cystic fibrosis (CF) patients, a study shows.
Gastroesophageal reflux disease (GERD, aka acid reflux), which occurs when acid from the stomach rises into the esophagus causing heartburn, is more common in CF patients — a prevalence of 35-81 percent — than in the general population.
Studies have suggested an association between GERD and poor pulmonary function, making it important to study GERD in CF. The most commonly used therapies to manage GERD belong to a class of drugs known as proton pump inhibitors (PPIs), which act as acid suppressors. It is unclear whether PPI use in CF patients can affect lung function, especially given the fact that previous studies have shown that PPIs are linked to community-acquired pneumonia.
The study, “Proton Pump Inhibitor Use Is Associated With an Increased Frequency of Hospitalization in Patients With Cystic Fibrosis,” was published in the journal Gastroenterology Research. It investigated a possible link between hospitalization as a result of pulmonary exacerbations and the use of PPIs by CF patients.
The study included 114 CF patients seen at the University of Florida Adult CF Center who were followed for a period of one year. PPI use among patients was defined as use for at least six months prior to the study and continued use throughout the year in which the study was conducted.
PPIs were used by 51.8 percent of patients, with the most commonly used PPIs being omeprazole, pantoprazole, lansoprazole, and esomeprazole.
Importantly, researchers found there was a significant link between the long-term use of PPIs and hospitalization for pulmonary exacerbations; the mean annual number of hospitalizations was 1.4 for PPI users, compared with 0.9 for non-PPI users.
Given these results and the wide use of PPIs, the researchers emphasized that “prescribers of PPI therapy should exercise pharmacovigilance; frequently re-evaluating indications and appropriateness of therapy and in the setting of GER considering alternate management modalities such as anti-reflux surgery where appropriate,” they wrote.
The study also has implications for PPI use outside the CF setting.
“People have a meal and feel heartburn and are often reflexively placed on a proton pump inhibitor … and that is not how things should be,” lead researcher of the study, Fares Ayoub, MD, said in a press release.
“Proton pump inhibitors are great medications. They really work. But they’re not benign. All we are doing is advocating that the right patients be on them,” Ayoub said.