Occurrence and significance of gastric colonization during acid-inhibitory therapy

Williams, Craig

doi:10.1053/bega.2001.0191

Cited by 88 publications

(64 citation statements)

References 66 publications

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“…29 Acid suppression medications are implicated in alteration of bowel flora of the upper and lower gastrointestinal tract. Bacteria in the small and large intestines increase in number in the conditions with decreased gastric acid.…”

Section: Discussionmentioning

confidence: 99%

Gastric Acid Suppression and Outcomes in Clostridium difficile Infection: A Population-Based Study

Khanna

Aronson

Kammer

et al. 2012

Mayo Clinic Proceedings

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Objective: To evaluate the association of gastric acid suppression medications, including proton pump inhibitors and histamine type 2 blockers, with outcomes in patients with Clostridium difficile infection (CDI) in a population-based cohort. Patients and Methods: To understand the association between acid suppression and outcomes in patients with CDI, we conducted a population-based study in Olmsted County, Minnesota, from January 1, 1991, through December 31, 2005. We compared demographic data and outcomes, including severe, severe-complicated, and recurrent CDI and treatment failure, in a cohort of patients with CDI who were treated with acid suppression medications with these outcomes in a cohort with CDI that was not exposed to acid-suppressing agents. Results: Of 385 patients with CDI, 36.4% were undergoing acid suppression (23.4% with proton pump inhibitors, 13.5% with histamine type 2 blockers, and 0.5% with both). On univariate analysis, patients taking acid suppression medications were significantly older (69 vs 56 years; PϽ.001) and more likely to have severe (34.2% vs 23.6%; Pϭ.03) or severecomplicated (4.4% vs 2.6% CDI; Pϭ.006) infection than patients not undergoing acid suppression. On multivariable analyses, after adjustment for age and comorbid conditions, acid suppression medication use was not associated with severe or severecomplicated CDI. In addition, no association between acid suppression and treatment failure or CDI recurrence was found. Conclusion: In this population-based study, after adjustment for age and comorbid conditions, patients with CDI who underwent acid suppression were not more likely to experience severe or severe-complicated CDI, treatment failure, or recurrent infection.

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Section: Discussionmentioning

confidence: 99%

Gastric Acid Suppression and Outcomes in Clostridium difficile Infection: A Population-Based Study

Khanna

Aronson

Kammer

et al. 2012

Mayo Clinic Proceedings

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“…22 The normal stomach acidity is an important host defence against ingested pathogens and provides protection against enteric infections. 7 We hypothesized that the decreased gastric acidity induced by the use of proton pump inhibitors increases the susceptibility of hospital patients to colonization and subsequent infection with C. difficile. Significant bacterial overgrowth and even colonization with fecal type bacteria 6 has been demonstrated in the upper gastrointestinal tract of patients receiving acid suppressive therapy, 7 with higher counts in patients taking proton pump inhibitors, 6 presumably because these agents are more effective than H 2 blockers at blocking gastric acid secretion.…”

Section: Discussionmentioning

confidence: 99%

“…We have postulated that decreased gastric acidity results in inadequate sterilization of ingested organisms, but other mechanisms are possible. Proton pump inhibitors may also contribute to the disruption of the bowel flora by allowing bacterial colonization of the stomach and upper small intestine; 7 however, it is unclear what effect this might have on colonic flora. Use of proton pump inhibitors may then contribute significantly to outbreaks of C. difficile diarrhea by resulting in increased numbers of susceptible hosts as well as possibly increasing the numbers of carriers in the population.…”

Section: Discussionmentioning

confidence: 99%

Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies

Dial¹,

Al-Rasadi²,

Manoukian

et al. 2004

Canadian Medical Association Journal

521

304

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“…Low gastric pH is thought to be a major factor that suppresses microbial colonization of the stomach (40), but some enteric bacteria possess acid resistance mechanisms (5) that may confer protection in the GI tract. However, many innate defense mechanisms break down in PEG tube patients, because the lack of sensory stimuli associated with food intake inhibits saliva production and peristalsis, while reduced swallowing increases the pH and reduces gastric nitrite concentrations.…”

mentioning

confidence: 99%

Effect of pH and Antibiotics on Microbial Overgrowth in the Stomachs and Duodena of Patients Undergoing Percutaneous Endoscopic Gastrostomy Feeding

et al. 2005

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Enteral nutrition via a percutaneous endoscopic gastrostomy (PEG) tube is often part of management in patients with dysphagia due to neurological or oropharyngeal disease. Gastrostomy placement can affect normal innate defense mechanisms in the upper gut, resulting in bacterial overgrowth. In this study microbiological investigations were done with gastric and duodenal aspirates from 20 patients undergoing PEG tube placement and PEG tubes from 10 patients undergoing tube replacement. Aspirate and PEG tube microbiotas were assessed by using viable counts and selective solid media followed by aerobic and anaerobic incubation to assess cell viabilities. The antibiotic susceptibility profiles of the isolates were determined by the disk diffusion method, and gas chromatography was used to study the bacterial metabolic products in the aspirates. The aspirates and PEG tubes contained mainly streptococci, staphylococci, lactobacilli, yeasts, and enterobacteria. Enterococci were detected only in PEG tube biofilms and not in aspirates. Gastric pH affected the composition of the aspirate microbiotas but not the total microbial counts. Staphylococci, Escherichia coli, and Candida spp. were isolated only from antibiotic-treated patients, despite the sensitivities of the bacteria to the agents used. Antibiotic treatment had no effect on the incidence of infection or the length of hospital stay in these patients.

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Occurrence and significance of gastric colonization during acid-inhibitory therapy

Cited by 88 publications

References 66 publications

Gastric Acid Suppression and Outcomes in Clostridium difficile Infection: A Population-Based Study

Gastric Acid Suppression and Outcomes in Clostridium difficile Infection: A Population-Based Study

Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies

Effect of pH and Antibiotics on Microbial Overgrowth in the Stomachs and Duodena of Patients Undergoing Percutaneous Endoscopic Gastrostomy Feeding

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