Antacid Use in Infancy Linked to Higher Risk of Celiac Disease

Researchers reported an increased risk of death among PPI users.

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Using acid-suppressing medications to treat gastroesophageal reflux disease (GERD) in infants increases the risk of developing celiac disease by 50 percent, according to new research.

GERD is a common condition in the United States, with roughly 25 percent of infants experiencing gastroesophageal reflux symptoms at some point.

Potential Link but No Clear Correlation

A large study of nearly 80,000 children found that those given common infant reflux drugs were slightly more likely to show early signs of celiac disease compared with those who weren’t.

Researchers in Israel looked at how acid-suppressive therapy affects children’s health over time using data from Maccabi Healthcare Services, which covers about one-quarter of the Israeli population.

The study, recently published in JAMA Network Open, focused on children born between 2005 and 2020. The researchers divided the children based on whether they had received acid-suppressive therapy during their first six months. The children were followed to see how they were doing until they were age 10.

Researchers found that 1.6 percent of children treated with acid-suppressive therapy, such as proton pump inhibitors (PPIs) and histamine-2 receptor antagonists, tested positive for celiac disease autoimmunity. This was a significant difference from the 1 percent rate among nonusers.

PPIs are a widely used class of medications that reduce the production of stomach acid, with approximately 15 million Americans using them annually. The primary reason for PPI use in infants is GERD.

“No matter how we sliced and diced the data from this large data set, we saw the same thing: There’s an increased risk of death among PPI users,” Dr. Ziyad Al-Aly, senior author of the study, said in a statement.

The study authors stressed that these findings show a correlation, not causation, and they did not propose a mechanism for a potential link between acid-suppressive drugs and celiac disease.

Dr. Jacob Teitelbaum, a board-certified internist, cautioned against long-term use of PPI acid blockers. While many doctors prescribe these drugs for lifetime use, the Food and Drug Administration has recommended them for no more than one to two months in most cases. Long-term use of PPIs can lead to side effects such as increased risk of fractures and infections and may cause excess acid secretion when people are taken off of them, he said.

In addition to severe nutritional deficiencies, he said, they are associated with markedly increased risk of neurological issues, loss of bone density, and other problems. A much healthier alternative, Teitelbaum said, are H2 blockers such as Pepcid (famotidine).

While H2 blockers such as Pepcid and PPIs such as Prilosec and Nexium both reduce stomach acid, they do so by targeting different steps in the acid production process. H2 blockers block histamine receptors, but PPIs are more potent and block the final step of acid secretion.

Managing Acid Reflux

For adults with acid reflux, Teitelbaum pointed out that losing weight or improving digestion can help resolve symptoms.

“In the long term, this means increasing stomach acid and [using] plant-based, but not animal-based—which are poorly effective—digestive enzymes,” he said.

Acid reflux isn’t typically caused by excessive stomach acid but rather by impaired digestion that allows stomach contents to back up into the esophagus.

“If you improve digestion, the reflux becomes less likely,” Teitelbaum said.

According to Teitelbaum, ways to do this include making a salad dressing with two tablespoons of vinegar, or “If OK'd by your holistic physician, you can take betaine HCL tablets, two per meal. You can find them at most health food stores.”

He also recommends avoiding iced drinks with meals because the body’s digestive enzymes work best at 98.6 degrees.

“If certain foods still cause indigestion,” Teitelbaum said. “Don’t eat them; your body may be trying to tell you it’s junk food and doesn’t want it,” or you may be allergic to the food.