Jacobs JD¹, Wagner T², Gulotta G³, Liao C⁴, Li YC⁵, Bissonnette M⁵, Pekow J⁶. Dig Dis Sci. 2019 Feb 6. doi: 10.1007/s10620-019-5474-4. [Epub ahead of print]

Author information

1 Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA.

2 Department of Medicine, University of Chicago, Chicago, IL, USA

3 Center for Research Informatics, University of Chicago, Chicago, IL, USA.

4 Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.

5 Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Chicago, 900 East 57th St., MB #9, Chicago, IL, 60637, USA.

6 Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Chicago, 900 East 57th St., MB #9, Chicago, IL, 60637, USA. jpekow@bsd.uchicago.edu.

Abstract

BACKGROUND: Preclinical data demonstrate that activation of the renin-angiotensin system (RAS) contributes to mucosal inflammation, and RAS inhibition by angiotensin-converting-enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) improves colitis in animal models. Less is known regarding the effects of RAS inhibition on clinical outcomes in inflammatory bowel disease (IBD) patients.

AIM: Evaluate the impact of ACEI and ARB on clinical outcomes in IBD.

METHODS: Rates of IBD-related hospitalizations, operations, and corticosteroid use were evaluated retrospectively in two groups. First, 111 IBD patients taking an ACEI or ARB were compared to nonusers matched 1:1 based on sex, age, diagnosis, diseaselocation, and hypertension diagnosis. Second, outcomes in a cohort of 130 IBD patients were compared prior to and during ACEI/ARB exposure.

RESULTS: Compared to matched controls, all IBD patients together with ACEI/ARB exposure had fewer hospitalizations (OR 0.26, p < 0.01), operations (OR 0.08, p = 0.02), and corticosteroid prescriptions (OR 0.5, p = 0.01). Comparing outcomes before and during ACEI/ARB use, there were no differences in hospitalizations, operations, or corticosteroid use for all IBD patients together, but patients with UC had increased hospitalizations (0.08 pre- vs. 0.16 during ACEI/ARB exposure, p = 0.03) and decreased corticosteroid use (0.24 pre-ACEI/ARB vs. 0.12 during ACEI/ARB exposure, p < 0.01) during ACEI/ARB use.

CONCLUSIONS: IBD patients with ACEI/ARB exposure had fewer hospitalizations, operations, and corticosteroid use compared to matched controls. No differences in outcomes were observed in individuals on ACEI/ARB therapy when compared to a period of time prior to medication exposure.