Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use

Abstract

Background: Gut dysbiosis associated with the use of proton-pump inhibitors (PPIs) has been found to lead to the occurrence of infectious and inflammatory adverse events. A longitudinal observational cohort study has demonstrated the heightened risk of death associated with PPI use. Summary: We evaluated meta-analyses to determine the association between PPI use and infectious and inflammatory diseases. Meta-analyses showed that PPI use is a potential risk for the development of enteric infections caused by Clostridium difficile, as well as small intestinal bacterial overgrowth, spontaneous bacterial peritonitis, community-acquired pneumonia, hepatic encephalopathy, and adverse outcomes in inflammatory bowel disease. We also examined changes in the composition and function of the gut microbiota with the use of PPIs. PPI use significantly increased the presence of Streptococcaceae and Enterococcaceae, which are risk factors for C. difficile infection, and decreased that of Faecalibacterium, a commensal anti-inflammatory microorganism. Key Message: High-throughput, microbial 16S rRNA gene sequencing has allowed us to investigate the association between the gut microbiome and PPI use. Future prospective comparison studies are necessary to confirm this association, and to develop new strategies to prevent complications of PPI use

Pilot Study Indicates Helicobacter pylori Infection May Induce Small Intestinal Mucosal Injury

“…There is a need to observe the influence of vonoprazan on the small intestine with caution, because it was already reported that both PPI and vonoprazan induce change in intestinal bacterial flora [20]. Generally, PPI is highly beneficial for patients with acid-related disease, and their side effects are infrequent.…”

Acid suppression therapy and its association with spontaneous bacterial peritonitis incidence: A systemic review and meta‐analysis

“…In addition, PPI is empirically used in clinical practice in gastroesophageal varices bleeding patients, even if there is no related evidence‐based practice. Despite its robust and rapid efficacy in acid suppression, it also has some adverse effects, including Clostridium difficile infection, pneumonia, menopausal fracture, and hepatic encephalopathy, in cirrhotic patients . For patients with cirrhosis combined with gastroesophageal reflux and peptic ulcer, the treatment strategy and duration of PPI use needs to be standardized.…”

“…It is suggested that acid suppression therapy may lead to small intestinal bacterial overgrowth (SIBO), and participate in the pathogenesis of SBP. Some studies suggested that PPI therapy may be associated with SIBO and SBP …”

Passing the “Acid Test”: Do Proton Pump Inhibitors Affect the Composition of the Microbiome?

“…2 In recent metanalyses, PPI use was associated with a significant increase in Streptococcus and Enterococcus. 6 These changes were associated with an increased risk for the development of spontaneous bacterial peritonitis, community-acquired pneumonia, and enteric infections. Nevertheless, the exact mechanism by which these microbial community alterations affect disease susceptibility is still an active area of investigation.…”

“…This study corroborates prior studies that reported similar increases in Streptococcus and Enterococcus species. 1,6 Since the species that were differentially increased are those often associated with the oral microbiome, the authors suggested that the increase in gastric pH as a consequence of PPI therapy may have increased bacterial migration from the oral cavity to the intestinal lumen through decreased gastric acid-related bacterial killing.…”