P0039 - Use of Proton Pump Inhibitors Improves Mortality in Mild Acute Pancreatitis: A Nationwide Cohort Study

Mark Ayoub, MD¹, Julton Tomanguilo-Chumbe, MD¹, Lauren Searls, DO², Joel Chittazhattu, DO¹, Medha Rajamanuri, MD², Morgan B. Koontz, MS³, Frank Annie, PhD², Ebubekir Daglilar, MD^1
1West Virginia University-Charleston Area Medical Center, Charleston, WV; ²Charleston Area Medical Center, West Virginia State University Charleston Division, Charleston, WV; ³Charleston Area Medical Center, Charleston, WV

Introduction: Previous studies showed a potential anti-inflammatory effect of proton pump inhibitors (PPI) as well as possible inhibition of pancreatic secretion. This presents the question of their possible use in acute pancreatitis (AP). Current guidelines do not address the role of PPI and the present review for possible therapeutic use and safety needs to be improved. Therefore, our study addresses the role of PPI in the management of AP and their association with the different outcomes of AP.

Methods: We queried the Diamond Network through TriNetX-Research Network. This network included 92 healthcare organizations. Patients with mild acute pancreatitis with BISAP score of Zero regardless of etiology were divided into two cohorts; first cohort included patients on PPI, and second cohort included patients not on any PPI. Patients with BISAP score equal to or more than 1 or on PPI prior to study date were excluded. Two well-matched cohorts were created using 1:1 propensity-scored matching model between cohorts. Baseline patient characteristics are highlighted in table 1. We compared the incidence of ICU admission, mortality, and other associated complications.

Results: A total of 431,571 patients met the inclusion criteria. Of those, 32.9% (n=142,062) were on PPI, and 67% (n=289,509) were not on any PPI. After propensity matching, the sample included 115,630 patients on PPI vs 115,630 patients without PPI. The PPI group had a lower rate of mortality (3.7% vs 4.4%, p< 0.001), lower rate of ICU admission (3.9% vs 5.5%, p< 0.001), lower rate of necrotizing pancreatitis (1.1% vs 1.9%, p< 0.001), lower rate of Hospital-Acquired Pneumonia (HAP) (3.6% vs 4.9%, p< 0.001), lower rate of respiratory failure (2.8% vs 4.2%, p< 0.001), and a lower rate of Acute Kidney Injury (AKI) (6.9% vs 10.1%, p< 0.001). There was no statistical difference in the rate of Clostridium difficile infection between the two cohorts (0.9% vs 0.8%, p=0.5). See table 2.

Discussion: The use of PPI in mild acute pancreatitis with a BISAP score of Zero is beneficial and provides a mortality benefit. It also lowers the rate of ICU admission and improves outcomes. Prospective studies are needed to prove benefit.




Disclosures:


Mark Ayoub, MD¹, Julton Tomanguilo-Chumbe, MD¹, Lauren Searls, DO², Joel Chittazhattu, DO¹, Medha Rajamanuri, MD², Morgan B. Koontz, MS³, Frank Annie, PhD², Ebubekir Daglilar, MD¹. P0039 - Use of Proton Pump Inhibitors Improves Mortality in Mild Acute Pancreatitis: A Nationwide Cohort Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.