University of Nebraska Medical Center Omaha, NE, United States
Sara Ghoneim, MD1, Sherif Saleh, MD2, Nabil El Hage Chehade, MD2, Abdul Mohammed, MD2, Josue Davila, MD2, Ronnie Fass, MD3 1University of Nebraska Medical Center, Omaha, NE; 2MetroHealth Medical Center, Cleveland, OH; 3Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
Introduction: Studies have demonstrated that GERD is among the comorbidities that correlate with poorer outcomes in hospitalized patients with COVID-19. Proton pump inhibitors (PPI) increase the risk for enteric infections likely due to PPI effect on intra-gastric pH. However, evidence regarding the link between PPI use and COVID-19 is still conflicting. On the other hand, famotidine has been shown to correlate with improved clinical outcomes in hospitalized COVID-19 patients. We aimed to examine the relationship between COVID-19 risk and use of H2RB or PPIs in GERD patients.
Methods: Data was extracted from a large commercial database (Explorys, IBM) that aggregates electronic health records from 26 large nationwide healthcare systems. Only adult patients with diagnosis of GERD from January 1999-May 2021 and COVID-19 from December 2019-May 2021 were included. Baseline characteristics including race, gender, H2RB or PPI use and health insurance type and status were collected. Incidence of COVID-19 among risk groups were examined. Univariable and multivariable logistic regression analyses were performed.The presence of effect modification by H2RB use was examined. Multivariate model was stratified by H2RB use.
Results: We identified 6215670 GERD patients of which 4057825 (65%) were exclusive PPI users. A total of 1626345 (40%) used both H2RBs and PPIs and only 546930 (9%) used H2RBs alone. COVID-19 was diagnosed in 1140 (0.03%) patients using PPIs alone (62% females vs 38% males), 1300 (0.08%) users of both H2RB and PPI (68% females vs 32% males) and 190 (0.03%) patients using H2RBs alone (63% females vs 37% males). In univariate model, H2RB use was significantly associated with COVID-19 diagnosis OR 2.47 [2.29-2.66, P< 0.001]. COVID-19 risk was significantly modified if patient used both PPI and H2RB OR 1.92 [1.72-2.15, P< 0.001]. In multivariate model, after adjusting for covariates, PPI use was independently associated with COVID-19 diagnosis OR 3.4 [3.1-3.76, P< 0.001]. H2RB use alone was significantly associated with COVID-19 diagnosis OR 2.8 [2.35-3.2, P< 0.001]. But the use of both PPI and H2RB significantly reduced the risk of infection OR 0.63 [0.55-0.74, P< 0.001]. If the model was stratified by H2RB use, COVID-19 risk was reduced in PPI users but unchanged in patients regardless of their baseline demographics (Figure 1).
Discussion: In GERD patients, exclusive use of PPIs or H2RBs was significantly associated with COVID-19 diagnosis. Concurrent use may modify susceptibility to COVID-19.
Figure: Figure 1. Multivariable regression analysis stratified by histamine-2 receptor blockers (H2RB) use. A forest plot showing odds ratio (OR) and 95% confidence interval (CI) for the association between COVID-19 and select baseline demographic data in patients with gastroesophageal reflux disease (GERD).
Disclosures: Sara Ghoneim indicated no relevant financial relationships. Sherif Saleh indicated no relevant financial relationships. Nabil El Hage Chehade indicated no relevant financial relationships. Abdul Mohammed indicated no relevant financial relationships. Josue Davila indicated no relevant financial relationships. Ronnie Fass indicated no relevant financial relationships.
Sara Ghoneim, MD1, Sherif Saleh, MD2, Nabil El Hage Chehade, MD2, Abdul Mohammed, MD2, Josue Davila, MD2, Ronnie Fass, MD3. P1346 - Effect of Histamine-2 Receptor Blockers Use on COVID-19 Susceptibility in Patients With Gastroesophageal Reflux Disease (GERD): A Population-Based Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.