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Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy
Lucio Lombardo1, Monica Foti, Olga Ruggia
1Department of Gastroenterology, Mauriziano Umberto 1st Hospital, Torino, Italy. lombodilucio@yahoo.it
Background & Aims:
Proton pump inhibitors (PPIs) can cause diarrhea, enteric infections, and alter the gastrointestinal bacterial population by suppressing the gastric acid barrier. Among patients that received long term PPI treatment, we evaluated the incidence of small intestinal bacterial overgrowth (SIBO; assessed by glucose hydrogen breath test [GHBT]), the risk factors for development of PPI-related SIBO and its clinical manifestations, and the eradication rate of SIBO after treatment with rifaximin.
Methods:
GHBTs were given to 450 consecutive patients (200 with gastroesophageal reflux disease who received PPIs for a median of 36 months; 200 with irritable bowel syndrome [IBS], in absence of PPI treatment for at least 3 years; and 50 healthy control subjects that had not received PPI for at least 10 years). Each subject was given a symptoms questionnaire.
Results:
SIBO was detected in 50% of patients using PPIs, 24.5% of patients with IBS, and 6% of healthy control subjects; there was a statistically significant difference between patients using PPIs and those with IBS or healthy control subjects (P < .001). The prevalence of SIBO increased after 1 year of treatment with PPI. The eradication rate of SIBO was 87% in the PPI group and 91% in the IBS group.
Conclusions:
SIBO, assessed by GHBT, occurs significantly more frequently among long term PPI users than patients with IBS or control subjects. High dose therapy with rifaximin eradicated 87%-91% of cases of SIBO in patients who continued PPI therapy.
Insights
Long-term proton pump inhibitor (PPI) use significantly increases the risk of small intestinal bacterial overgrowth (SIBO). Rifaximin effectively eradicates SIBO in PPI users, even during continued PPI therapy.
Area of Science:
- Gastroenterology
- Microbiology
- Pharmacology
Background:
- Proton pump inhibitors (PPIs) suppress gastric acid, potentially altering gut microbiota and increasing susceptibility to enteric infections.
- Long-term PPI use is associated with gastrointestinal disturbances, including diarrhea and changes in bacterial populations.
Purpose of the Study:
- To evaluate the incidence of small intestinal bacterial overgrowth (SIBO) in long-term PPI users.
- To identify risk factors for PPI-related SIBO and its clinical manifestations.
- To determine the SIBO eradication rate with rifaximin in patients on PPI therapy.
Main Methods:
- A glucose hydrogen breath test (GHBT) assessed SIBO in 450 subjects: 200 PPI users, 200 irritable bowel syndrome (IBS) patients (no PPIs), and 50 healthy controls.
- Subjects completed a symptom questionnaire.
- PPI users received a median of 36 months of PPI treatment.
Main Results:
- SIBO prevalence was significantly higher in PPI users (50%) compared to IBS patients (24.5%) and healthy controls (6%) (P < .001).
- SIBO incidence increased after one year of PPI treatment.
- Rifaximin achieved an 87% SIBO eradication rate in PPI users and 91% in IBS patients.
Conclusions:
- Long-term PPI use is a significant risk factor for developing SIBO, as detected by GHBT.
- SIBO is more prevalent in PPI users than in IBS patients or healthy individuals.
- High-dose rifaximin therapy demonstrates high efficacy in eradicating SIBO among patients continuing PPI treatment.
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