(325) Use of Histamine-2 Receptor Antagonists and Risk of Inflammatory Bowel Diseases: A Systematic Review and Meta-analysis of Observational Studies

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number:

Presenting Author(s)

Vijayanarayana Kunhikatta, MPharm, PhD
– Associate Professor, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Manipal, Karnataka, India

Co-Author(s)

Freya D'sa
– Student, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
Elaine Fernandes
– Student, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
Srushti Kesarkar
– Student, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
Lavanya Swaminathan
– Student, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
Muhammed Rashid, MPharm, BPharm
– Research Scholar, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Manipal, Udupi, Karnataka, India
Girish Thunga
– Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Manipal, Karnataka, India
Viji Chandran
– Research scholar, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
Sreedharan Nair, MPharm, PhD, PhD
– Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India

Background: Histamine-2 receptor antagonists (H2RAs) are commonly prescribed drugs that were developed in the early 1990s. They are extremely well-tolerated and are used to treat various gastrointestinal disorders like gastric and duodenal ulcers, heartburn, gastroesophageal reflux disease (GERD), and are also a part of multidrug regimen in H. pylori eradication. Previous literature has established that gastric acid suppressants such as PPIs and H2RAs adversely affect the composition of gut microbial flora which may lead to IBD. But there is not enough evidence to support it. The cumulative risk of IBD following H2RA usage has not been well estimated so far in the available literature

Objectives: To collate all available evidence on the risk of IBD (CD, UC, and MC) following the use of H2RA through a systematic review and estimate the risk of IBD through a meta-analysis.

Methods: Databases such as MEDLINE/PubMed, Scopus, and Cochrane Library were searched from inception to January 2021. A bibliographic search of selected articles, random search in Google Scholar and ResearchGate were also performed for any additional studies. The observational studies which assessed the incidence or risk of IBD in H2RA users published in the English language were considered. Modified Downs and Black Checklist was used for quality assessment. Two independent reviewers were involved in study selection, data extraction and quality assessment; any discrepancies were settled through consensus or by consulting a third reviewer.

Results: Four studies out of 2,658 articles were included for this meta-analysis. The meta- analysis of 4 studies with 8939 participants revealed a significantly higher risk of IBD (OR: 2.27; 95%CI: 1.70-3.02; P< 0.0001) in H2RA users compared to non-users. Similar significant relationships were observed in the subgroup analysis of adults (P < 0.0001) and pediatrics (P=0.04). The quality of included studies was observed to be fair to good.

Conclusions: Our findings indicate a significantly higher IBD risk among those who used H2RA compared to non-users both in adults and pediatrics. Further observational studies involving large populations are required to strengthen these results and to generalize these findings.