Department of Internal Medicine, Drug Safety Monitoring Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110799, South Korea.
World J Gastroenterol. 2013 Jan 14;19(2):258-64. doi: 10.3748/wjg.v19.i2.258.
To evaluate the effect of proton pump inhibitors (PPIs) on the development of gastrointestinal tuberculosis.
All patients who were more than 20 years old and who had received a prescription for PPIs among those who visited Seoul National University Hospital from January 1, 2005 to December 31, 2009 were identified. Due to the low sensitivity of the microbiologic test and the nonspecific pathologic findings, the diagnosis of gastrointestinal tuberculosis was confirmed through the presence of active ulcerations and the responses to anti-tuberculosis medications. The patients were divided into two groups according to treatment duration (group 1: ≤ 3 mo; group 2: > 3 mo) and were followed up from the time they took the first prescription of PPIs until their last visit. Logistic regression analysis was used to calculate the relative risks (RR) and 95%CI, adjusting for covariates.
Among the 61, 834 patients exposed to PPIs (50,534 in group 1; 11,300 in group 2), 21 patients were diagnosed with PPI-associated gastrointestinal tuberculosis during 124,274 person-years of follow-up. Of 21 patients, the 12 who revealed only scar changes in the colonoscopy were excluded from the statistical analyses. Of those who remained, 2 were excluded because they underwent gastrointestinal endoscopy within 4 wk of the first prescription for PPIs. Longer exposure to PPI was associated with a higher mean age (55.0 ± 14.5 in group 1 vs 58.2 ± 13.3 in group 2, P < 0.001) and a higher Charlson co-morbidity index (0.50 ± 0.93 in group 1 vs 0.77 ± 1.14 in group 2, P < 0.001). The true incidence of active gastrointestinal tuberculosis was 0.65 per 1000 person-years in group 1 and 0.03 per 1 000 person-years in group 2. Like the less-than-three-month PPI treatment period in group 1, the over-three-month PPI therapy period in group 2 was not associated with increased risk of acquiring gastrointestinal tuberculosis, after adjusting for age and co-morbidities, whereas the Charlson co-morbidity index was associated with increased risk of acquiring gastrointestinal tuberculosis based on the score [RR: (reference 1) in group 1 vs 1.518 in group 2; 95% CI: 1.040-2.216, P = 0.03].
Long-term PPI therapy does not seem to be associated with increased risk of acquiring gastrointestinal tuberculosis, but a higher Charlson co-morbidity index is associated with such.
评估质子泵抑制剂（PPIs）对胃肠道结核发展的影响。
从 2005 年 1 月 1 日至 2009 年 12 月 31 日期间在首尔国立大学医院就诊的所有年龄超过 20 岁且接受过 PPI 处方的患者均被纳入研究。由于微生物学检测的敏感性较低和非特异性病理发现，通过存在活动性溃疡和对抗结核药物的反应来确认胃肠道结核的诊断。根据治疗时间（组 1：≤3 个月；组 2：>3 个月）将患者分为两组，并从首次开具 PPI 处方开始随访至最后一次就诊。使用 logistic 回归分析计算调整协变量后的相对风险（RR）和 95%CI。
在接受 PPI 治疗的 61834 名患者（组 1：50534 名；组 2：11300 名）中，在 124274 人年的随访期间，有 21 名患者被诊断为 PPI 相关性胃肠道结核。在 21 名患者中，有 12 名在结肠镜检查中仅显示结肠瘢痕改变，这些患者被排除在统计分析之外。在其余患者中，有 2 名患者因为在首次开具 PPI 处方后 4 周内进行了胃肠内镜检查而被排除。较长时间的 PPI 暴露与较高的平均年龄（组 1：55.0±14.5；组 2：58.2±13.3，P<0.001）和较高的 Charlson 合并症指数（组 1：0.50±0.93；组 2：0.77±1.14，P<0.001）相关。组 1 的活动性胃肠道结核的真实发病率为 0.65/1000 人年，组 2 的发病率为 0.03/1000 人年。与组 1 的小于 3 个月的 PPI 治疗期一样，组 2 的超过 3 个月的 PPI 治疗期与胃肠道结核发病风险增加无关，调整年龄和合并症后，而 Charlson 合并症指数与胃肠道结核发病风险相关（RR：（参考 1）组 1 比组 2为 1.518；95%CI：1.040-2.216，P=0.03）。
长期 PPI 治疗似乎不会增加获得胃肠道结核的风险，但较高的 Charlson 合并症指数与该风险相关。
