Journal of Gastroenterology

, Volume 53, Issue 4, pp 507–516 | Cite as

Proton pump inhibitors as risk factor for metabolic syndrome and hepatic steatosis in coeliac disease patients on gluten-free diet

  • Nicola ImperatoreEmail author
  • Raffaella Tortora
  • Anna Testa
  • Nicolò Gerbino
  • Nicola Caporaso
  • Antonio Rispo
Original Article—Alimentary Tract



Recent research has shown that patients with coeliac disease (CD) are at risk of developing metabolic syndrome (MS) and hepatic steatosis (HS) after commencing a gluten-free diet (GFD). This study aimed to evaluate the predictive factors for MS and HS in CD after 1 year of GFD.


All consecutive newly diagnosed CD patients were enrolled. We prospectively collected data about BMI; waist circumference; blood pressure; cholesterol; triglycerides, glucose and insulin blood levels; insulin resistance (through the homeostatic model assessment HOMA-IR) and treatment with proton pump inhibitors (PPI). Diagnosis of MS was made in accordance with current guidelines and HS was diagnosed by ultrasonography. The prevalence of MS and HS was re-assessed after 1 year of GFD. A logistic regression analysis was performed to identify risk factors for MS and HS occurrence after 1 year of GFD.


Of 301 patients with newly diagnosed CD, 4.3% met criteria for diagnosis of MS and 25.9% presented with HS at the time of CD diagnosis; 99 subjects (32.8%) had long-term exposure to PPI during the study period. After 1 year, 72 (23.9%) patients had developed MS (4.3 vs 23.9%; p < 0.001, OR 6.9) and 112 (37.2%) had developed HS (25.9 vs 37.2%; p < 0.01, OR 1.69). At multivariate analysis, high BMI at diagnosis (OR 10.8; p < 0.001) and PPI exposure (OR 22.9; p < 0.001) were the only factors associated with the occurrence of MS; HOMA-IR (OR 9.7; p < 0.001) and PPI exposure (OR 9.2; p < 0.001) were the only factors associated with the occurrence of HS.


PPI exposure adds further risk of occurrence of MS and HS for patients with CD on GFD. The use of PPI in patients with CD on GFD should be limited to strict indications.


Coeliac disease Proton pump inhibitors Metabolic syndrome Hepatic steatosis 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

535_2017_1381_MOESM1_ESM.docx (127 kb)
Supplementary material 1 (DOCX 127 kb)


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Copyright information

© Japanese Society of Gastroenterology 2017

Authors and Affiliations

  1. 1.Gastroenterology, Department of Clinical Medicine and SurgerySchool of Medicine “Federico II” of NaplesNaplesItaly
  2. 2.Hepatology UnitAORN CardarelliNaplesItaly

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