Risk of small intestinal bacterial overgrowth in patients receiving proton pump inhibitors <i>versus</i> proton pump inhibitors plus prokinetics

Revaiah, Pruthvi C; Kochhar, Rakesh; Rana, Satya Vati; Berry, Neha; Ashat, Munish; Dhaka, Narendra; Reddy, Yalaka Rami; Sinha, Saroj Kant

doi:10.1002/jgh3.12045

Cited by 22 publications

(20 citation statements)

References 42 publications

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“…A more recent paper found that the use of prokinetics in patients on PPIs may reduce the risk of SIBO, by enhancing intestinal motility. 61 A very interesting Italian study 62 showed that while patients with nonerosive reflux disease who received PPIs for typical reflux-related symptoms obtained relief from heartburn and regurgitation, they complained of new onset, SIBO-related, bowel symptoms, whose incidence increased over time. Glucose hydrogen breath test was found positive in 11/42 (26%) subjects and-by a post hoc analysis-a significant (P < 0.05) percentage of patients (8/42) met the Rome III criteria for IBS.…”

Section: Clinical Consequences Of Ppi-induced Changes In Intestinal Mmentioning

confidence: 99%

Potential proton pump inhibitor–related adverse effects

Perry

Sonu

Scarpignato

et al. 2020

Annals of the New York Academy of Sciences

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Proton pump inhibitors (PPIs) are one of the most common medications taken by patients worldwide. PPIs are used to treat acid‐related disorders, including gastroesophageal reflux disease, peptic ulcer disease, Helicobacter pylori infection, and nonsteroidal anti‐inflammatory drug/stress ulceration. For some of these diseases, long‐term treatment is necessary. With such prolonged use, concern and investigation into potential adverse effects has increased. In addition, data are available regarding potential anticancer effects of PPIs, especially regarding solid tumors. The aim of this review is to assess the literature on PPIs with regard to common concerns, such as drug–drug interactions, the intestinal microbiome, dementia and central nervous system disease, and osteoporosis, as well as to highlight potential negative and positive impacts of the drug in cancer.

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Section: Clinical Consequences Of Ppi-induced Changes In Intestinal Mmentioning

confidence: 99%

Potential proton pump inhibitor–related adverse effects

Perry

Sonu

Scarpignato

et al. 2020

Annals of the New York Academy of Sciences

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“…The notion that a slowed intestinal transit may predispose to SIBO is supported by two recent studies in adults (90, 91). In the most recent study, by Revaiah et al (90), two patient groups (i.e., PPI-group and PPI + prokinetic group) underwent a GHBT and lactulose hydrogen breath test (LHBT) and orocecal transit time assessment. Interestingly, SIBO was documented more frequently in the PPI alone group than in the PPI + prokinetic group, and SIBO-positive patients had slower orocecal transit times than SIBO-negative patients.…”

Section: Risk Factors For Sibomentioning

confidence: 86%

Small Intestinal Bacterial Overgrowth in Children: A State-Of-The-Art Review

et al. 2019

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Small intestinal bacterial overgrowth (SIBO) is a heterogenous and poorly understood entity characterised by an excessive growth of select microorganisms within the small intestine. This excessive bacterial biomass, in turn, disrupts host physiology in a myriad of ways, leading to gastrointestinal and non-gastrointestinal symptoms and complications. SIBO is a common cause of non-specific gastrointestinal symptoms in children, such as chronic abdominal pain, abdominal distention, diarrhoea, and flatulence, amongst others. In addition, it has recently been implicated in the pathophysiology of stunting, a disease that affects millions of children worldwide. Risk factors such as acid-suppressive therapies, alterations in gastrointestinal motility and anatomy, as well as impoverished conditions, have been shown to predispose children to SIBO. SIBO can be diagnosed via culture-dependant or culture-independent approaches. SIBO's epidemiology is limited due to the lack of uniformity and consensus of its diagnostic criteria, as well as the paucity of literature available. Antibiotics remain the first-line treatment option for SIBO, although emerging modalities such as probiotics and diet manipulation could also have a role. Herein, we present a state-of-the-art-review which aims to comprehensively outline the most current information on SIBO in children, with particular emphasis on the gut microbiota.

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“…The second possible mechanism is related to intestinal bacterial overgrowth and translocation. PPIs, as acid suppressors, are known to induce intestinal dysbiosis and subsequent development of small intestinal bacterial overgrowth [25][26][27]. The complication of small intestinal bacterial overgrowth is more problematic among patients with cirrhosis than in healthy individuals, as they tend to have some degree of immunodeficiency through several mechanisms, including loss of Kupffer in the hepatic reticuloendothelial system, imbalance of cytokines causing immune cell dysfunction, and decreased hepatic synthesis of complements and acute phase reactants [4,11,28,29].…”

Section: Discussionmentioning

confidence: 99%

Use of proton pump inhibitors is associated with a higher risk of pneumonia in cirrhotic patients: a systematic review and meta-analysis

Wongtrakul¹,

Charoenngnam²,

Ungprasert

2020

aog

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Background Proton pump inhibitors (PPIs) are commonly prescribed for cirrhotic patients. However, the use of PPIs in these patients may increase the risk of bacterial infection. The current study aimed to investigate the risk of developing pneumonia among cirrhotic patients exposed to PPIs. Methods A literature search was independently conducted by 2 investigators using the MEDLINE and EMBASE databases up to September 2019. To be eligible, a study had to be an observational (cohort, case-control or cross-sectional) study that included one group of cirrhotic patients with PPI use and another group of cirrhotic patients without PPI use. Effect estimates of the association between PPI use and pneumonia had to be reported. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. Results Of 1947 articles identified from the 2 databases, 3 cohort and 5 cross-sectional studies with 40,295 participants met the eligibility criteria and were included in the meta-analysis. The pooled analysis found that cirrhotic patients with a history of PPI use had a significantly higher risk of developing pneumonia than those without PPI use, with a pooled risk ratio of 1.36 (95% confidence interval 1.00-1.85; I 2 47%). Conclusion A significantly increased risk of pneumonia among cirrhotic patients exposed to PPIs was demonstrated in this study.

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Risk of small intestinal bacterial overgrowth in patients receiving proton pump inhibitors versus proton pump inhibitors plus prokinetics

Cited by 22 publications

References 42 publications

Potential proton pump inhibitor–related adverse effects

Potential proton pump inhibitor–related adverse effects

Small Intestinal Bacterial Overgrowth in Children: A State-Of-The-Art Review

Use of proton pump inhibitors is associated with a higher risk of pneumonia in cirrhotic patients: a systematic review and meta-analysis

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