Abstract
Introduction
Proton pump inhibitors (PPIs) are commonly prescribed drugs. Chronic PPI use has recently been associated with the risk for developing small intestinal bacterial overgrowth (SIBO). It is not known whether the short-term prescription of a PPI can trigger SIBO. Therefore, the aim of the present study was to evaluate the incidence of SIBO and gastrointestinal symptoms after 7 days of PPI use.
Materials and Methods
A prospective, pilot, open-label study was conducted on asymptomatic healthy volunteers. The incidence of SIBO was evaluated at the baseline and after administration of 40 mg of pantoprazole once a day for 7 days, through a glucose breath test. In addition, the presence of gastrointestinal symptoms, the number of bowel movements, and the consistency of stools, according to the Bristol scale, were assessed.
Results
Thirty-eight healthy subjects (71.1% women, mean age 25.18 ± 6.5 years) were analyzed. The incidence of SIBO after 7 days of PPI administration was 7.8% (95% CI 1.6–21.3%). The patients that developed SIBO had a greater prevalence of bloating (p = 0.0002) and flatulence (p = 0.004) after 7 days of treatment.
Conclusions
Our study showed that a short-term 7-day PPI course produced SIBO in 7.8% of healthy subjects. Although, inappropriate use of PPIs should be discouraged, but since more than 90% of subjects who received PPIs for one week did not develop SIBO, the advantages of PPI administration seem to outweigh the disadvantages.
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References
Schnoll-Sussman F, Niec R, Katz P. Proton pump inhibitors. The good, bad, and ugly. Gastrointest Endosc Clin N Am. 2020;30239–251.
Kahrilas PJ, Shaheen NJ, Vaezi MF et al. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology 2008;135:1383–1391.
Huerta-Iga F, Bielsa-Fernández MV, Remes-Troche JM, Valdovinos-Díaz MA, Tamayo-de la Cuesta JL; en representación del Grupo para el estudio de la ERGE 2015. Diagnosis and treatment of gastroesophageal reflux disease: recommendations of the Asociación Mexicana de Gastroenterología. Diagnóstico y tratamiento de la enfermedad por reflujo gastroesofágico: recomendaciones de la Asociación Mexicana de Gastroenterología. Rev Gastroenterol Mex. 2016;81:208–222.
Kantor ED, Rehm CD, Haas JS et al. Trends in Prescription Drug Use Among Adults in the United States From 1999–2012. JAMA 2015;314:1818–1831.
Compare D, Pica L, Rocco A et al. Effects of long-term PPI treatment on producing bowel symptoms and SIBO. Eur J Clin Invest. 2011;41:380–386.
Vaezi MF, Yang YX, Howden CW. Complications of proton pump inhibitor therapy. Gastroenterology 2017;153:35–48.
Eusebi LH, Rabitti S, Artesiani ML et al. Proton pump inhibitors: Risks of long-term use. J Gastroenterol Hepatol. 2017;32:1295–1302.
Freedberg DE, Kim LS, Yang YX. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology. 2017;152:706–715.
Pereira SP, Gainsborough N, Dowling RH. Drug-induced hypochlorhydria causes high duodenal bacterial counts in the elderly. Aliment Pharmacol Ther 1998;12:99–104.
Lewis SJ, Franco S, Young G et al. Altered bowel function and duodenal bacterial overgrowth in patients treated with omeprazole. Aliment Pharmacol Ther 1996;10:557–561.
Lo WK, Chan WW. Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth: a meta-analysis. Clin Gastroenterol Hepatol. 2013;11:483–490.
Su T, Lai S, Lee A, He X, Chen S. Meta-analysis: proton pump inhibitors moderately increase the risk of small intestinal bacterial overgrowth. J Gastroenterol. 2017;52:27–36.
Bavishi C, Dupont HL. Systematic review: the use of proton pump inhibitors and increased susceptibility to enteric infection. Aliment Pharmacol Ther 2011;34:1269–1281.
Brophy S, Jones KH, Rahman MA et al. Incidence of Campylobacter and Salmonella infections following first prescription for PPI: a cohort study using routine data. Am J Gastroenterol 2013;108:1094–1100.
Hafiz RA, Wong C, Paynter S, David M, Peeters G. The Risk of Community-Acquired Enteric Infection in Proton Pump Inhibitor Therapy: Systematic Review and Meta-analysis. Ann Pharmacother. 2018;52:613–622.
Wu HH, Chen YT, Shih CJ, Lee YT, Kuo SC, Chen TL. Association between recent use of proton pump inhibitors and nontyphoid salmonellosis: a nested case-control study. Clin Infect Dis. 2014;59:1554–1558.
Neal KR, Scott HM, Slack RC, Logan RF. Omeprazole as a risk factor for campylobacter gastroenteritis: case-control study. BMJ 1996;312:414–415.
Zavala-Gonzales MA, Azamar-Jacome AA, Meixueiro-Daza A et al. Validation and diagnostic usefulness of gastroesophageal reflux disease questionnaire in a primary care level in Mexico. J Neurogastroenterol Motil. 2014;20:475–482.
Rentz AM, Kahrilas P, Stanghellini V et al. Development and psychometric evaluation of the patient assessment of upper gastrointestinal symptom severity index (PAGI-SYM) in patients with upper gastrointestinal disorders. Qual Life Res. 2004;13:1737–1749.
Rezaie A, Buresi M, Lembo A et al. Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. Am J Gastroenterol. 2017;112:775–784.
Cares K, Al-Ansari N, Macha S et al. Short article: risk of small intestinal bacterial overgrowth with chronic use of proton pump inhibitors in children. Eur J Gastroenterol Hepatol. 2017;29:396–399.
Lombardo L, Foti M, Ruggia O, Chiecchio A. Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy. Clin Gastroenterol Hepatol. 2010;8:504–508.
Malfertheiner P, Kandulski A, Venerito M. Proton-pump inhibitors: understanding the complications and risks. Nat Ret Gastroenterol Hepatol. 2017;14:697–710.
Singh A, Kirby DF. Proton pump inhibitors: Risks and rewards and emerging consequences to the gut microbiome. Nutr Clin Pract. 2018;33:614–624.
Naito Y, Kashiwagi K, Takagi T, Andoh A, Inoue R. Intestinal dysbiosis secondary to proton-pump inhibitor use. Digestion. 2018;97:195–204.
Parkman HP, Urbain JL, Knight LC et al. Effect of gastric acid suppressants on human gastric motility. Gut 1998;42:243–250.
Goddard AF, Spiller RC. The effect of omeprazole on gastric juice viscosity, pH, and bacterial counts. Aliment Pharmacol Ther 1996;10:105–109.
Sieczkowska A, Landowski P, Gibas A, Kamińska B, Lifschitz C. Long-term proton pump inhibitor therapy leads to small bowel bacterial overgrowth as determined by breath hydrogen and methane excretion. J. Breath Res. 2018;12:036006.
Freeman R, Dabrera G, Lane C et al. Association between use of proton pump inhibitors and non-typhoidal salmonellosis identified following investigation into an outbreak of Salmonella mikawasima in the UK, 2013. Epidemiol Infect. 2016;144:968–975.
Garcia Rodriguez LA, Ruigomez A, Panes J. Use of acid-sup- pressing drugs and the risk of bacterial gastroenteritis. Clin Gastroenterol Hepatol. 2007;5:1418–1423.
Pimentel M. Evaluating a bacterial hypothesis in IBS using a modification of Koch’s postulates: part 1. Am J Gastroenterol. 2010;105:718–721.
Spiegel BM, Chey WD, Chang L. Bacterial overgrowth and irritable bowel syndrome: unifying hypothesis or a spurious consequence of proton pump inhibitors? Am J Gastroenterol. 2008;103:2972–2976.
Bruno G, Zaccari P, Rocco G et al. Proton pump inhibitors and dysbiosis: Current knowledge and aspects to be clarified. World J Gastroenterol. 2019;25:2706–2719. https://doi.org/10.3748/wjg.v25.i22.2706.
Giamarellos-Bourboulis EJ, Pyleris E, Barbatzas C, Pistiki A, Pimentel M. Small intestinal bacterial overgrowth is associated with irritable bowel syndrome and is independent of proton pump inhibitor usage. BMC Gastroenterol. 2016;16:67.
Pimentel M, Saad RJ, Long MD, Rao SSC. ACG Clinical Guideline: Small intestinal bacterial overgrowth. Am J Gastroenterol 2020;115:165–178.
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JMRT acts as guarantor of the article. CDR and JMRT wrote the paper. JMRT, JAVRV, and MAB designed the research study and analyzed the data. CDR, BAPP, LAMJ, EMC, ATR, and CAAR performed the research and collected the data. All authors approved the final version of the article, including the authorship list.
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JMRT has served as advisory board for Takeda, Asofarma, and Biocodex, and is also a speaker for Takeda, Asofarma, Alfasigma, Carnot, Chinoin, Medtronic, Ferrer, and Sanofi. MAB and JAVRV are speakers for Takeda and Asofarma. CDR has received and educational grant form Medtronic. BAPP, LAMJ, EMC, ATR, and CAAR do not have conflict of interest.
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Durán-Rosas, C., Priego-Parra, B.A., Morel-Cerda, E. et al. Incidence of Small Intestinal Bacterial Overgrowth and Symptoms After 7 Days of Proton Pump Inhibitor Use: A Study on Healthy Volunteers. Dig Dis Sci 69, 209–215 (2024). https://doi.org/10.1007/s10620-023-08162-2
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DOI: https://doi.org/10.1007/s10620-023-08162-2