Meta-analysis: proton pump inhibitors moderately increase the risk of small intestinal bacterial overgrowth

Su, Tingting; Lai, Shih-Kung; Lee, Allen; He, Xingkang; Chen, Shujie

doi:10.1007/s00535-017-1371-9

Cited by 137 publications

(90 citation statements)

References 53 publications

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“…Among the 19 eligible studies, 7 found a positive association between PPI intake and increased risk for SIBO, whereas the remaining 12 studies did not show a statistically significant relationship. They concluded that the pooled estimate of the 19 studies demonstrated that PPI use was significantly associated with a moderately increased risk of SIBO (OR 1.71, 95% CI 1.20-2.43) [26]. These findings persisted even on subgroup analysis when studies were examined using different control populations as well as different modalities to diagnose SIBO, such as culture of small bowel aspirates and glucose hydrogen breath tests.…”

Section: Infectious and Inflammatory Diseases Possibly Associated Witmentioning

confidence: 66%

“…In addition, subgroup analysis revealed an association between SIBO and PPI use in studies that used duodenal or jejunal aspirate cultures to diagnose SIBO (OR 7.587, 95% CI 1.805-31.894), but no relationship was found between SIBO and PPI use in studies that used the glucose hydrogen breath test (OR 1.93, 95% CI 0.69-5.42) [25]. In 2017, Su et al [26] reviewed recently published peer-reviewed evidence to evaluate the risk of SIBO among PPI users. Among the 19 eligible studies, 7 found a positive association between PPI intake and increased risk for SIBO, whereas the remaining 12 studies did not show a statistically significant relationship.…”

Section: Infectious and Inflammatory Diseases Possibly Associated Witmentioning

confidence: 99%

“…Two meta-analyses clearly showed that PPI use is a risk factor for the development of small intestinal bacterial overgrowth (SIBO), which is defined as >10 5 bacterial colony-forming units per milliliter upon culturing upper gut aspirates [25,26]. Lo et al [25] demonstrated that the pooled OR of SIBO in PPI users vs. nonusers was 2.282 (95% CI, 1.238-4.205).…”

Section: Infectious and Inflammatory Diseases Possibly Associated Witmentioning

confidence: 99%

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Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use

Naito

Kashiwagi²,

Takagi³

et al. 2018

Digestion

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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

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Section: Infectious and Inflammatory Diseases Possibly Associated Witmentioning

confidence: 66%

Section: Infectious and Inflammatory Diseases Possibly Associated Witmentioning

confidence: 99%

Section: Infectious and Inflammatory Diseases Possibly Associated Witmentioning

confidence: 99%

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Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use

Naito

Kashiwagi²,

Takagi³

et al. 2018

Digestion

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“…As a result, it is considered that small intestinal bacterial flora is changed to induce small intestinal mucosal injury. Recently, metaanalysis and reviews, including our own, report the statistical relationship between PPI and small intestinal bacterial overgrowth [15][16][17]; and that H. pylori eradication changes intestinal bacterial flora [18]. Thus, there is a high possibility that H. pylori infection induces small intestinal dysbiosis.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Background and Aim: Helicobacter pylori infection is a primary cause of gastroduodenal ulcers. To investigate whether there is an association between H. pylori infection and small intestinal mucosal injury. Methods: Patients were selected from a general pool of subjects who underwent capsule endoscopy for current or past obscure gastrointestinal bleeding. Characteristics including age, gender, history, treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and/or acid suppressant, diagnosis, and H. pylori infection were investigated. Patients infected with H. pylori had positive test result, ranging 30 days before to 30 days after capsule endoscopy. Patients diagnosed with inflammatory diseases, malignant tumors, etc. were excluded. All video images were re-evaluated to count small intestinal mucosal breaks. Eligible patient variables were compared. Results: A total of 92 patients (30 infected with H. pylori/62 uninfected) were eligible. By univariate analysis of the number of mucosal breaks, patients treated with NSAIDs were found to have more mucosal breaks than patients untreated (38%: 8/21 vs. 18%: 13/71; p = 0.004), and the possible association was detected between patients infected with H. pylori and those who were not (67%: 14/21 vs. 37%: 26/71; p = 0.081). When comparing the H. pylori infected and uninfected patients, the rate of patients with mucosal breaks was greater in infected patients (47%: 14/30 vs. 11%: 7/62; p = 0.001). After excluding patients treated with NSAIDs, the number of mucosal breaks was also greater in patients infected with H. pylori (1.2 ± 1.5 vs. 0.38 ± 0.62; p = 0.001). Conclusion: There is a possibility that H. pylori infection induces small intestinal mucosal injury.

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“…Bacterial translocation from the gut flora to mesenteric lymph nodes underlies the pathogenesis of SBP . It has been shown that long‐term suppression of gastric acid secretion results in bacterial overgrowth both in the stomach and intestine . However, their studies were not limited to patients with LC.…”

Section: Discussionmentioning

confidence: 99%

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

Lin

Hou

Deng

et al. 2019

Hepatology Research

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Aim It is well known that the use of proton pump inhibitor (PPI) is widespread in patients with liver cirrhosis. PPI counteracts H2 receptor inhibitor (H2RA) with its strong acid suppression effect. However, there is always a concern that PPI use may increase spontaneous bacteria peritonitis (SBP) development in cirrhotic patients. We aimed to investigate the association between acid suppression therapy (i.e. PPI or H2RA) and SBP through meta‐analysis. Methods We searched PubMed, Medline, Web of Science, Cochrane library, and Embase for relevant studies published up to April 2019. Pooled OR and 95% CI were calculated by a random‐effects model. Funnel plots and Egger's tests were performed for the evaluation of publication bias. Non‐parametric “trim‐and‐fill” tests were conducted for sensitivity analysis. Results A total of 20 original articles including 9566 cirrhotic patients were analyzed. The overall meta‐analysis highlighted that PPI use was associated with the risk of SBP (pooled OR 1.77, 95% CI 1.49–2.11). The conclusion was irrespective of study methods, whereas the result was inconsistent only in South America. However, the conclusion might not be stable enough and should be extrapolated with caution. Unlike PPI, we found H2RA was not associated with SBP (pooled OR 1.06, 95% CI 0.75–1.48). Conclusions In conclusion, PPI use, but not H2RA, will increase the incidence of SBP in cirrhotic patients. In addition, H2RA might be beneficial for patients who require long‐term acid suppression therapy.

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Meta-analysis: proton pump inhibitors moderately increase the risk of small intestinal bacterial overgrowth

Cited by 137 publications

References 53 publications

Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use

Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use

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

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

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