| アブストラクト | OBJECTIVE: To determine whether the use of proton pump inhibitors (PPIs) compared with the use of histamine-2 receptor antagonists (H2RAs) is associated with an increased risk of inflammatory bowel disease (IBD). DESIGN: Population-based cohort study designed to address the impact of protopathic bias. SETTING: General practices contributing data to the UK Clinical Practice Research Datalink GOLD. PARTICIPANTS: 1 498 416 initiators of PPIs and 322 474 initiators of H2RAs from 1 January 1990 to 31 December 2018, with follow-up until 31 December 2019. Patients were analysed according to the timing of the IBD diagnosis after treatment initiation (early vs late). MAIN OUTCOME MEASURES: Standardised morbidity ratio weighted Cox proportional hazards models were used to estimate marginal HRs and 95% CIs. In the early-event analysis, IBD diagnoses were assessed within the first 2 years of treatment initiation, an analysis subject to potential protopathic bias. In the late-event analysis, all exposures were lagged by 2 years to account for latency and minimise protopathic bias. RESULTS: In the early-event analysis, the use of PPIs was associated with an increased risk of IBD within the first 2 years of treatment initiation, compared with H2RAs (HR 1.39, 95% CI 1.14 to 1.69). In contrast, the use of PPIs was not associated with an increased risk of IBD in the late-event analysis (HR 1.05, 95% CI 0.90 to 1.22). The results remained consistent in several sensitivity analyses. CONCLUSIONS: Compared with H2RAs, PPIs were not associated with an increased risk of IBD, after accounting for protopathic bias. |
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| 投稿者 | Abrahami, Devin; Pradhan, Richeek; Yin, Hui; Yanofsky, Russell; McDonald, Emily Gibson; Bitton, Alain; Azoulay, Laurent |
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| 組織名 | Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,;Massachusetts, USA.;Epidemiology, Biostatistics, and Occupational Health, McGill University,;Montreal, Quebec, Canada.;Center for Clinical Epidemiology, Lady Davis Institute for Medical Research,;Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada.;Medicine, McGill University Health Centre, Montreal, Quebec, Canada.;Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.;Medicine, McGill University, Montreal, Quebec, Canada.;Montreal, Quebec, Canada laurent.azoulay@mcgill.ca.;Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec,;Canada. |
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