质子泵抑制剂诱发痛风性关节炎急性发作病例回顾并可能机制分析

Proton pump inhibitor use associated with an increased risk of gout: A population-based case-control study

OBJECTIVES

In previous reports, proton pump inhibitor (PPI) use increased the risk of gout. However, there is no epidemiological study investigating this association. We aimed to examine the potential impact of PPI treatment on the risk of developing gout.

METHODS

A population-based case-control study was performed using a Longitudinal Health Insurance Database 2000 from Taiwan (population 23 million). We identified gout cases and non-gout controls through propensity score matching at 1:1, which was matched by sex and age. We used a conditional logistic regression model to estimate an odds ratio and 95% confidence intervals (CI) for gout population versus controls.

RESULTS

Esomeprazole increased the risk of gout after adjusting confounding variables (adjusted odds ratio [aOR] 1.3; 95% CI 1.0-1.6). The risk of gout was highest within 30 days of PPI treatment (aOR 1.7; 95% CI 1.4-1.9) and attenuated thereafter. The risk of gout was increased among female users of PPI compared with male users (aOR 2.2; 95% CI 1.7-2.8). The aOR of gout in people with PPI use was higher in middle-aged individuals (41-60 years: aOR 2.1; 95% CI 1.7-2.7) than in the older group (≥60 years: aOR 1.8; 95% CI 1.5-2.2).

CONCLUSIONS

Our findings provide population-level evidence for the hypothesis that PPI treatment is positively associated with the risk of developing gout. Further research on the mechanism underlying this association is warranted.

Clinical characteristics of acute gout induced by omeprazole and its S-isomer

BACKGROUND

Proton pump inhibitors inhibit gastric acid secretion by blocking H⁺-K⁺-ATPase in gastric parietal cells. In addition to common adverse reactions such as drug allergies, proton pump inhibitors may also cause acute gout attacks in patients with gout, but clinicians do not know enough that proton pump inhibitors may cause the acute attack of gouty arthritis, whose pathogenesis is still unclear.

AIM

To analyze the clinical characteristics of acute gout arthritis induced by omeprazole and its S-isomer (esomeprazole).

METHODS

The clinical data of 11 patients who were hospitalized at Tianjin Fifth Central Hospital from November 2020 to May 2021 and developed an acute attack of gout arthritis after using omeprazole and its S-isomer were analyzed.

RESULTS

There were nine (81.8%) males and two (18.2%) females. The mean age was 56.73 ± 15.4 years. The clinical diagnoses were chronic gastritis in six (54.5%) cases, acute upper gastrointestinal bleeding in two (18.2%), duodenal bulb ulcer in one (9.1%), enteritis in one (9.1%), and jejunal stromal tumor with bleeding in one (9.1%). Five (45.5%) cases used esomeprazole, and six used omeprazole; both were intravenously administered. Clinical manifestations were redness, swelling, and pain of single or multiple joints. The uric acid levels of the 11 patients were all higher than normal, and the uric acid level after using omeprazole and its S-isomer was significantly higher than before (t = -0.81, P = 0.00). The time between using omeprazole and its S-isomer to onset of acute gout arthritis was 4.73 ± 4.10 d; there was no significant difference in the time between patients with and without anemia (t = -0.37, P = 0.72), between patients with elevated creatinine levels and those with normal creatinine levels (t = 0.48, P = 0.65), and between patients who received esomeprazole compared with those who received omeprazole (t = 0.78, P = 0.46).

CONCLUSION

Omeprazole and its S-isomer induce the acute attack of gout arthritis, which may be related to the inhibition of renal H⁺-K⁺-ATPase and the reduction of uric acid excretion.

Acid suppressants use and the risk of dementia: A population-based propensity score-matched cohort study

In this population-based propensity score matched (PSM) cohort study, we aimed to investigate the risk of developing dementia with the use of acid suppressants, including proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2 antagonists). Cohorts of PPI users (n = 2,778), H2 antagonist users (n = 6,165), and non-users (n = 86,238) were selected from a dataset covering the years 2000 to 2010 in Taiwan’s National Health Insurance Research Database. Patients in the three groups were PSM at a ratio of 1:1 within each comparison cohort (CC). Three CCs were created: (1) PPI users compared to non-users (CC1, n = 2,583 pairs); (2) H2 antagonist users compared to non-users (CC2, n = 5,955 pairs); and (3) PPI users compared to H2 antagonist users (CC3, n = 2,765 pairs). A multivariable robust Cox proportional hazard model was used to estimate the adjusted hazard ratio (aHR) and the 95% confidence interval (CI) for the risk of developing dementia. The multivariable analysis results show that the aHR of developing dementia during the follow-up period was 0.72 (CC1: 95% CI = 0.51–1.03, P = 0.07) for PPI users and 0.95 (CC2: 95% CI = 0.74–1.22, P = 0.69) for H2 antagonist users, when compared to non-users. Between the patients using acid suppressants, there was no difference between PPI and H2 antagonist users in the risk of developing dementia (CC3: aHR = 0.82, 95% CI = 0.58–1.17, P = 0.28). In conclusion, no association was observed between the use of acid suppressants and the risk of developing dementia in any of the three CCs. Further, randomized controlled trials are warranted to confirm this relationship.