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16S community profiling identifies proton pump inhibitor related differences in gastric, lung, and oropharyngeal

Rachel Rosen1, Lan Hu2, Janine Amirault1

  • 1Aerodigestive Center, Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA.

The Journal of Pediatrics
|February 10, 2015
PubMed

Insights

Proton pump inhibitor (PPI) use alters gut bacteria, potentially affecting lung and throat microbes through reflux. Gastric and lung bacteria showed closer relationships, suggesting aspiration of reflux contributes to these changes.

Area of Science:

  • Microbiology
  • Gastroenterology
  • Pulmonology

Background:

  • Proton pump inhibitors (PPIs) are widely used medications.
  • Their impact on the human microbiome, particularly in the upper gastrointestinal and respiratory tracts, is an area of ongoing research.
  • Understanding these effects is crucial for evaluating potential side effects and optimizing treatment.

Purpose of the Study:

  • To investigate the hypothesis that proton pump inhibitor (PPI) use leads to alterations in gastric microflora.
  • To determine if these gastric microflora changes, via full column reflux, subsequently affect lung and oropharyngeal microflora.
  • To explore the relationship between PPI dosage and observed microflora changes.

Main Methods:

  • A prospective, cross-sectional cohort study involving 116 children with chronic cough.
  • Participants were divided into two groups: those on PPIs (n=59) and those not on PPIs (n=57).
  • Simultaneous bronchoscopy and upper endoscopy were performed, with 16S sequencing of gastric, bronchoalveolar lavage, and oropharyngeal fluids. Multichannel intraluminal impedance testing was conducted on 50 patients.

Main Results:

  • Increased abundance of Streptococcus in the gastric fluid of children on PPIs, correlating with PPI dosage.
  • Significant differences in oropharyngeal Streptococcus abundance were observed in PPI-treated patients.
  • Eight bacterial genera were found in gastric and lung fluids but not oropharyngeal, indicating site exchange. Lactococcus and Acinetobacter were more abundant with greater reflux, suggesting aspiration. Principal component analysis showed greater overlap between gastric and lung microflora compared to oropharyngeal.

Conclusions:

  • Proton pump inhibitor (PPI) use is associated with distinct changes in gastric, lung, and oropharyngeal microflora.
  • While microflora exchange occurs among these sites, gastric and lung microflora exhibit a closer relationship.
  • Aspiration of full column reflux is proposed as a potential mechanism for microflora exchange between the gastric and lung environments.
Abstract

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