[Proton-pump inhibitor therapy and small bowel bacterial contamination]

Area of Science:

• Gastroenterology
• Microbiology

Background:

• Proton pump inhibitors (PPIs) are widely used for acid suppression.
• Long-term PPI use has been increasingly associated with gastrointestinal symptoms and small intestinal bacterial overgrowth (SIBO).
• Understanding the impact of PPIs on the gut microbiome is crucial.

Purpose of the Study:

• To investigate the prevalence of SIBO in patients on long-term proton pump inhibitor therapy.
• To evaluate treatment strategies for PPI-associated SIBO.

Main Methods:

• Utilized hydrogen breath tests (HBT) for diagnosing SIBO.
• Conducted investigations across two medical centers.
• Analyzed data from patients undergoing long-term PPI treatment.

Main Results:

• A positive hydrogen breath test (indicating SIBO) was observed in 21% of patients on long-term PPIs.
• Probiotics were effective in achieving symptom-free conditions for uncomplicated cases.
• Rifaximin demonstrated high efficacy and fewer side effects for chronic SIBO compared to systemic antibiotics.

Conclusions:

• Long-term proton pump inhibitor therapy is associated with a significant prevalence of small intestinal bacterial overgrowth.
• Treatment approaches should be tailored, with probiotics for mild cases and antibiotics, particularly Rifaximin, for chronic SIBO.