Can PPI Use for IBD Influence Severity of Periodontal Disease?

This commentary originally appeared on Consultant360.com. 

Proton pump inhibitors (PPIs) are known to reduce the clinical manifestations of gastrointestinal reflux disease. However, they can also impact the gastrointestinal and oral microbiota and influence bone metabolism.

Previous research has shown a positive association between inflammatory bowel disease (IBD) and inflammatory host response following bacterial infection characteristic of periodontal disease.

A new study¹ led by Lisa Yerke, DDS, MS, an American Board of Periodontology Diplomate and clinical assistant professor at the University at Buffalo, found an inverse relationship between PPI use and severity of periodontal disease.

In the study, Yerke and colleagues evaluated medical and dental history records of 581 individuals aged 35 years or older diagnosed with generalized, moderate to severe chronic periodontitis. The researchers measured periodontal disease severity for each participant by calculating the number of teeth with periodontal pocket depths of 6 mm or greater.

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: How did your study come about?

Lisa Yerke: We were aware of evidence suggesting that PPI might have effects 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, but there are studies suggesting that PPI use is associated with a decrease in microbial diversity but an increase in the number of bacteria (small intestinal bacterial overgrowth and an increase in Clostridium difficile infections are associated with PPI use). Gastroenterologists might prescribe PPIs to treat a variety of conditions, such as gastric reflux 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 between periodontal pocket depths and PPI use was.

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, and to obtain information relevant to the mechanism through which PPI use might affect periodontal disease progression.

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.