5 Questions About PPI Use and Periodontal Disease in IBD
Proton pump inhibitors (PPIs) can reduce the clinical manifestations of gastrointestinal reflux disease (GERD). However, they can also impact the gastrointestinal and oral microbiota, as well as influence bone metabolism.
Previous research indicates a positive association between inflammatory bowel disease (IBD) and inflammatory host response following bacterial infection characteristic of periodontal disease.
A study1 led by Lisa Yerke, DDS, MS, clinical assistant professor at the University at Buffalo School of Dental Medicine in New York, and an American Board of Periodontology Diplomate, found an inverse relationship between PPI use and severity of periodontal disease.
Overall, 15.7% of teeth from participants with periodontal disease taking PPIs had periodontal pocket depths of 6 mm or greater compared with 22.6% of teeth among participants with periodontal disease who did not take PPIs (95% CI, 2.2-11.5). This inverse relationship remained even after adjusting for diabetes and smoking.
Gastroenterology Consultant caught up with Yerke to talk about her research that was recently presented during a poster session at the 2018 Advances in Inflammatory Bowel Disease Meeting.
Gastroenterology Consultant: What prompted you to conduct your study?
Lisa Yerke: We were aware of evidence suggesting that PPI use might have an effect on bone metabolism and the gastrointestinal microbiota. Consequently, we performed a retrospective clinical study to see whether there was a relationship between PPI use and periodontal disease, which is a bacterially-mediated disease resulting in bone loss around teeth.
GASTRO CON: Why can PPIs negatively impact oral microbiota? How do you think a gastroenterologist can approach this when managing a patient with IBD?
LY: The precise mechanism has yet to be determined. However, there are studies suggesting that PPI use is associated with a decrease in microbial diversity, but an increase in the number of bacteria. Gastroenterologists might prescribe PPIs to treat a variety of conditions, such as GERD and symptoms of IBD. However, PPIs might have effects on other diseases and conditions as well, with some of these effects being beneficial.
GASTRO CON: Your study found an inverse relationship between PPI use for IBD and severity of periodontal disease. Were you surprised by the findings?
LY: We were surprised at how strong the level of significance was between periodontal pocket depths and PPI use.
GASTRO CON: Do you think the association between PPI use and periodontal disease is related to immunologic and microbiologic factors associated with IBD?
LY: The potential PPI-periodontal relationship might be related to immunologic and microbiologic factors that also are associated with IBD, but further studies will be needed to determine the precise mechanism, since our study did not suggest a mechanism, only an association.
GASTRO CON: What is the next step in your research?
LY: We are planning prospective human trials, animal studies, as well as immunologic studies, to assess the PPI-periodontal relationship in individuals with varying severity of periodontal and IBD disease. We would like to obtain information relevant to the mechanism through which PPI use might affect periodontal disease progression.
For more AIBD Meeting content, visit the AIBD Newsroom.
Reference:
Yerke L, Levine M, Cohen R. Treatment of IBD with proton pump inhibitors: Implications for periodontal disease. Poster #007. Presented at: Advances in Inflammatory Bowel Diseases; December 13-15, 2018; Orlando, FL. https://www.consultant360.com/meetings/aibd.
