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Association between anti-acid therapies and advanced fibrosis in type 2 diabetics with biopsy-proven non-alcoholic fatty liver disease

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Abstract

Backgrounds and Aims

Data on associations of antacid therapies with advanced fibrosis (AF) in patients with non-alcoholic fatty liver disease (NAFLD) are limited. We aimed to assess the association of histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) with AF in NAFLD patients with underlying type 2 diabetes (T2D).

Methods

We retrospectively reviewed patient’s charts with T2D who had a liver biopsy for suspected NAFLD. Fibrosis stages were determined as F0–F4, AF being F3–4. Laboratory data and use of various medications within 24 months of liver biopsies were used for the analysis. Univariable and multivariable logistic regression analyses were performed to assess any association.

Results

Our cohort consisted of 1008 T2D patients with biopsy-proven NAFLD. Sixty-six percent were female, 86.2% were Caucasian, and median HbA1C was 6.4%. AF was present in 32% of the patients. Thirty-four percent were on H2RAs and 60.6% were on PPI therapy (p < 0.001) for a median duration of 3.6 [0.10, 3.8] (p = 0.20) and 45.6 [0.80, 15.4] (p = 0.17) months, respectively. On multivariable logistic regression analysis being on H2RAs was associated with a 68% lower risk of AF (odds ratio [OR] [95%CI]: 0.32 [0.24, 0.44]) (p < 0.001), but use of PPIs showed a trend towards higher risk of AF (OR [95%CI]: 1.4 [1.00, 1.8]) (p = 0.053).

Conclusion

Our study suggests that H2RAs are associated with lower risk of AF in NAFLD patients with underlying diabetes and should be considered as the first-line antacid therapy in these patients. Risk stratification should be done if PPIs are indicated in high-risk diabetics with NAFLD.

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Contribution of authors

Study concept and design: AS, NA; acquisition of data: AS; analysis and interpretation of data: all authors; drafting of the manuscript and critical revision of the manuscript for important intellectual content: all authors; statistical analysis: NL, AS, NA; administrative, technical, or material support: all authors; study supervision: NA

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Author notes

  1. Amandeep Singh and Rajat Garg contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, Hepatology and Center for Human Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, A5 Annex, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Amandeep Singh, Nan Lan & Mohamed Tausif Siddiqui

  2. Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA

    Rajat Garg & Mohit Gupta

  3. Texas Liver Institute, University of San Antonio, San Antonio, TX, USA

    Naim Alkhouri

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  1. Amandeep Singh
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Correspondence to Amandeep Singh.

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Conflict of interest

AS, RG, NL, MTS, MG, and NA declare that they have no conflict of interest.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

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Poster Presentation at American Association of Study of Liver Disease National Meeting, 2018, San Francisco, CA, USA

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Singh, A., Garg, R., Lan, N. et al. Association between anti-acid therapies and advanced fibrosis in type 2 diabetics with biopsy-proven non-alcoholic fatty liver disease. Indian J Gastroenterol 39, 591–598 (2020). https://doi.org/10.1007/s12664-020-01087-y

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