ConexiantEarly Infant Antacid Use Linked to Celiac

This large Israeli cohort study (n=79,820) examined potential associations between early infant acid-suppressive therapy and celiac disease autoimmunity development. Divergent results from two study designs suggest healthcare utilization confounding rather than causal relationship, with the test-negative control design showing no significant association.

⚕️ Key Clinical Considerations ⚕️

• Statistical Significance Variance: Cohort design showed 52% increased risk (HR 1.52, 95% CI 1.33-1.74), while test-negative design found no significant association (OR 1.07, 95% CI 0.94-1.23).
• Methodology Strengths: Test-negative design effectively controlled for healthcare-seeking behavior confounding, providing more reliable causal inference than traditional cohort analysis.
• Duration-Response Pattern: Longer AST exposure (>1 month) demonstrated higher risk in cohort analysis (HR 1.65), suggesting potential dose-dependent relationship.
• Testing Bias Impact: AST users underwent CDA testing at significantly higher rates (44.9% vs 32.1%), indicating surveillance bias in positive associations.
• Diagnostic Limitations: Study relied on serologic testing without biopsy confirmation, potentially overestimating true celiac disease incidence rates.

🎯 Clinical Practice Impact 🎯

• Patient Communication: Reassure parents that early AST use likely doesn’t causally increase celiac risk, emphasizing that observed associations reflect healthcare utilization patterns rather than medication effects.
• Practice Integration: Continue evidence-based AST prescribing for appropriate indications without celiac disease concerns, while maintaining awareness of potential surveillance bias in pediatric populations.
• Risk Management: Document clear clinical indications for AST use in infants, ensuring prescribing decisions aren’t influenced by unfounded autoimmune disease concerns.
• Action Items: Educate families about appropriate AST indications and avoid unnecessary restrictions based on suspected but unproven celiac associations.

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