Virginia Via Research Day Book 2026

Medical Student Research Clinical

27 CHRONIC PPI USAGE AND MULTIPLE SCLEROSIS

Christopher Cesiro; Athena Lee; Hisham Zahid; Julie Kidd, PharmD, MPH, BCPS Corresponding author: alee02@vcom.edu

VCOM-Virginia, Blacksburg, Virginia

PPI. Then, we will use an online calculator to determine significance. Statistical Consideration: Confounding variables with other comorbidities of these patient populations; PPI usage has a lot of drug interactions and various side effects to be mindful of. For example, there is a side effect of Vitamin D deficiency, which could also be playing a confounding role in this data. Results: Our expected results will display a significant correlation between long-term PPI usage and the development of multiple sclerosis.

Context: Proton pump inhibitors are one of the most widely prescribed medications used to reduce gastric acid secretion. Evidence suggests the long-term use of proton pump inhibitors may alter the gut microbiome, which may contribute to immune dysregulation. Studies have suggested a possible association between long term PPI use and autoimmune diseases. However, little known about the long-term use of proton pump inhibitors and its effects on the central nervous system. This study aims to explore the possible association between PPI use and demyelinating disorders, with a specific focus on multiple sclerosis. Using the All of Us Research Program database, we will evaluate whether PPI exposure is associated with subsequent diagnoses of multiple sclerosis, which will be identified via Electronic Health Record. Biomarkers such as cobalamin or vitamin B12 levels will be assessed to help distinguish true demyelinating disorders from clinical mimics. Imaging techniques such as T-2 weighted Magnetic Resonance Imaging will be used to strengthen case validation and improve accuracy of identifying demyelinating disease. Research Question: Is chronic PPI use associated with an increased risk of developing multiple sclerosis?

Objective/Hypothesis: We hypothesize that long-term PPI usage could be linked to the development of demyelinating disorders such as MS, in conjunction with B12 deficiency. Methods: Parse data from All of Us on PPI usage, B12 deficiency, and MS diagnoses, utilizing Chi squared statistical analysis to track any correlation. Several thousand data points have been collected from the database, but not yet processed and organized. The primary cohort being investigated has the conditions of PPI exposure and an MS diagnosis, which the database contains over 9,000 data points for. Several concept sets were created to further filter the population of interest, including serum B12 levels, MCV, start and end date of Rx, referral to neurologist, GERD/PUD diagnosis, vitamin D deficiency, and MRI of the head. To determine if there is a significant difference in the risk of demyelinating disorder between those using PPI versus those not using PPI, we will use the Chi-squared testbased on the above cohorts in All of Us. To do so, we will set up a 2x2 table with counts of patients with and without the disorder and those using and not using

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198 Edward Via College of Osteopathic Medicine (VCOM)