The impacts of acid suppression on duodenal microbiota during the early phase of severe acute pancreatitis

Ma, Xiao; Huang, Libin; Huang, Zhiyin; Jiang, Jinsun; Zhao, Chong; Tong, Huan; Feng, Zhe; Gao, Jinhang; Li, Rui; Zhang, Mingguang; Zhou, Ming; Tan, Qing; Liu, Ling; Tang, Chengwei

doi:10.1038/s41598-020-77245-1

Cited by 9 publications

(7 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Supporting this, a previous study reported that PPIs use can increase the risk of cholangitis ( Min et al, 2019 ). In addition, PPIs may cause alterations in the gut microbiome, and which may facilitate the development of systemic and local infections prior to severe acute pancreatitis ( Clooney et al, 2016 ; Ma et al, 2020 ). The total period of hospital stay and mortality rate will likely increase for patients with intraperitoneal infection or pancreatic necrosis ( Rashid et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Proton Pump Inhibitors Were Associated With Reduced Pseudocysts in Acute Pancreatitis: A Multicenter Cohort Study

et al. 2021

View full text Add to dashboard Cite

Background: Acute pancreatitis (AP) is a systemic inflammatory disorder with a wide spectrum of clinical symptoms that can range from mild to severe. Previous preclinical study results suggest that proton pump inhibitors (PPIs) can inhibit exocrine pancreatic secretion and exert anti-inflammatory properties, which might in turn improve the outcome of AP.Aim: We conducted this multicenter, retrospective cohort study to investigate the potential effects of PPIs on the mortality, and total duration of hospital stay and local complication occurrence of patients with AP.Methods: A total of 858 patients with AP were included. All patients presented to the hospital within 48 h of symptom onset and were divided into the following two groups: patients who were treated with PPIs (n = 684) and those not treated with PPIs (n = 174). We used propensity score matching (PSM) analysis to reduce confounding bias before comparing the outcomes between the two groups.Results: Before PSM analysis, there were significant differences in a number of parameters between the two groups, including age, sex, hematocrit, blood urea nitrogen, peritonitis signs, Ranson’s score, and Acute Physiology Chronic Health Evaluation II score and organ failure occurrence. Before PSM, the PPIs group had a higher rate of mortality than the control group [RR = 1.065; 95% confidence ratio (CI) 1.045–1.086; p = 0.001]. After PSM, there was no significant difference in mortality (RR = 1.009; 95% CI, 0.999–1.019; p = 0.554) or total hospital stay (p = 0.856), although the PPIs group had a lower occurrence of pancreatic pseudocyst (RR = 0.416; 95% CI 0.221–0.780; p = 0.005).Conclusion: This study showed that PPIs therapy was not associated with reduced mortality or total hospital stay, but was associated with a reduction in the occurrence of pseudocysts in patients with acute pancreatitis.

show abstract

Section: Discussionmentioning

confidence: 99%

Proton Pump Inhibitors Were Associated With Reduced Pseudocysts in Acute Pancreatitis: A Multicenter Cohort Study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In addition, the results of this study are consistent with the results of recent studies. PPIs induce duodenal bacterial overgrowth and have been shown to be associated with the development of severe acute pancreatitis and recurrent cholelithiasis, and our study suggests important microbiome changes in these developments after PPI use [ 48 , 49 ].…”

Section: Discussionmentioning

confidence: 92%

Effect of a Proton Pump Inhibitor on the Duodenum Microbiome of Gastric Ulcer Patients

Lim

Shin

Park

2022

Life

View full text Add to dashboard Cite

The gut microbiota are regarded as a functional organ that plays a substantial role in human health and disease. Proton pump inhibitors (PPIs) are widely used in medicine but can induce changes in the overall gut microbiome and cause disease-associated dysbiosis. The microbiome of the duodenum has not been sufficiently studied, and the effects of PPIs on the duodenal microbiome are poorly understood. In this study, we investigated the effect of PPI administration on duodenum microbiota in patients with a gastric ulcer. A total of 12 gastric ulcer patients were included, and PPI (Ilaprazole, Noltec®, 10 mg) was prescribed in all patients for 4 weeks. A total of 17 samples from the second portion of the duodenum were analyzed. Microbiome compositions were assessed by sequencing the V3–V4 region of the 16s rRNA gene (Miseq). Changes in microbiota compositions after 4 weeks of PPI treatment were analyzed. a-Diversity was higher after PPI treatment (p = 0.02, at Chao1 index), and β-diversity was significantly different after treatment (p = 0.007). Welch’s t-test was used to investigate changes in phyla, genus, and species level, and the abundance of Akkermansia muciniphila, belonging to the phylum Verrucomicrobia, and Porphyromonas endodontalis, belonging to the phylum Bacteroidetes, was significantly increased after treatment (p = 0.044 and 0.05). PPI administration appears to induce duodenal microbiome dysbiosis while healing gastric ulcers. Further large-scale studies on the effects of PPIs on the duodenal microbiome are required.

show abstract

“…However, prolonged PPI use may cause dysbiosis in the GI tract 84 and lead to infectious complications, as shown in its association with cholangitis 85–88 . In the early phase of severe AP, PPI‐induced alterations in the low‐pH environment were reported to result in duodenal dysbiosis, although infectious complications did not increase in patients receiving PPIs in an RCT 89 . Furthermore, the reduced secretion of gastric acid resulting from PPIs may impair gastric acid‐based chemical debridement of necrotic tissue in WON drained by LAMS.…”

Section: Nutrition and Probioticsmentioning

confidence: 99%

“…[85][86][87][88] In the early phase of severe AP, PPI-induced alterations in the low-pH environment were reported to result in duodenal dysbiosis, although infectious complications did not increase in patients receiving PPIs in an RCT. 89 Furthermore, the reduced secretion of gastric acid resulting from PPIs may impair gastric acid-based chemical debridement of necrotic tissue in WON drained by LAMS. In a retrospective study of LAMS for WON, 90 PPI use was associated with increases in stent occlusion (20.1% vs. 9.5%) and the mean number of DEN sessions (4.6 vs. 3.2 sessions).…”

Section: Nutrition and Probioticsmentioning

confidence: 99%

Time to think prime times for treatment of necrotizing pancreatitis: Pendulum conundrum

Nakai,

Hamada,

Saito

et al. 2023

Digestive Endoscopy

View full text Add to dashboard Cite

Pancreatic fluid collections (PFCs) typically develop as local complications of acute pancreatitis and complicate the clinical course of patients with acute pancreatitis and potentially fatal clinical outcomes. Interventions are required in cases of symptomatic walled‐off necrosis (WON) (matured PFCs with necrosis) and pancreatic pseudocysts (matured PFCs without necrosis). In the management of necrotizing pancreatitis and WON, endoscopic ultrasound‐guided transluminal drainage combined with on‐demand endoscopic necrosectomy (i.e. the step‐up approach) is increasingly used as a less invasive treatment modality compared with a surgical or percutaneous approach. Through the substantial research efforts and development of specific devices and stents (e.g. lumen‐apposing metal stents), endoscopic techniques of PFC management have been standardized to some extent. However, there has been no consensus about timing of carrying out each treatment step; for instance, it is uncertain when direct endoscopic necrosectomy should be initiated and finished and when a plastic or metal stent should be removed following clinical treatment success. Despite emerging evidence for the effectiveness of noninterventional supportive treatment (e.g. antibiotics, nutritional support, irrigation of the cavity), there has been only limited data on the timing of starting and stopping the treatment. Large studies are required to optimize the timing of those treatment options and improve clinical outcomes of patients with PFCs. In this review, we summarize the current available evidence on the indications and timing of interventional and supportive treatment modalities for this patient population and discussed clinical unmet needs that should be addressed in future research.

show abstract

The impacts of acid suppression on duodenal microbiota during the early phase of severe acute pancreatitis

Cited by 9 publications

References 37 publications

Proton Pump Inhibitors Were Associated With Reduced Pseudocysts in Acute Pancreatitis: A Multicenter Cohort Study

Proton Pump Inhibitors Were Associated With Reduced Pseudocysts in Acute Pancreatitis: A Multicenter Cohort Study

Effect of a Proton Pump Inhibitor on the Duodenum Microbiome of Gastric Ulcer Patients

Time to think prime times for treatment of necrotizing pancreatitis: Pendulum conundrum

Contact Info

Product

Resources

About