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Short article: Risk of small intestinal bacterial overgrowth with chronic use of proton pump inhibitors in children
Kristen Cares1, Namir Al-Ansari, Suhasini Macha
1aDepartment of Pediatric Gastroenterology bChildren's Research Center, Children's Hospital of Michigan, Detroit, Michigan.
Insights
Proton pump inhibitor (PPI) use in children may increase the risk of small intestinal bacterial overgrowth (SIBO), though this study found no statistically significant link. Further research is needed to confirm the potential SIBO risk in pediatric PPI users.
Area of Science:
- Pediatric Gastroenterology
- Microbiome Research
- Pharmacology
Background:
- Proton pump inhibitors (PPIs) are theorized to increase small intestinal bacterial overgrowth (SIBO) risk due to chronic acid suppression.
- Hypochlorhydria from PPIs may alter the gut environment, promoting bacterial growth.
- Previous studies on PPIs and SIBO risk in adults yielded mixed results, with limited data in children.
Purpose of the Study:
- To assess the risk of SIBO in children using PPIs compared to a control group.
- To investigate the association between long-term PPI use and SIBO in a pediatric population.
Main Methods:
- Prospective cohort study design.
- SIBO evaluation via glucose hydrogen breath test in children under 18.
- Comparison of PPI users (≥6 months) with healthy controls, analyzing breath hydrogen/methane levels over 2 hours.
Main Results:
- 83 children participated; 56 used PPIs, 27 were controls.
- SIBO detected in 8.9% of PPI users versus 3.7% of controls.
- Relative risk for SIBO in PPI users was 2.4, but not statistically significant (P=0.359).
Conclusions:
- This is the first study to assess SIBO risk in pediatric PPI users in English literature.
- Results suggest a potential, though not statistically significant, risk of SIBO with chronic PPI use in children.
- Findings are significant given the common and prolonged prescription of PPIs for pediatric conditions.
Background:
Some theorize that prolonged use of proton pump inhibitors (PPIs) may increase the risk of small intestinal bacterial overgrowth (SIBO). Chronic acid suppression and resultant hypochlorhydria may lead to an altered intraluminal environment, which, in turn, may promote the growth of bacteria in the small intestine. A handful of studies measured the risk of SIBO in adults taking PPIs and obtained mixed results; however, this risk has not been exclusively measured in children.
Aim:
This study aimed to measure the risk of SIBO in children taking PPI versus those not taking PPI.
Patients And Methods:
This was a prospective cohort study. Evaluation of SIBO was performed using the glucose hydrogen breath test. Patients younger than 18 years of age taking a PPI longer than 6 months were compared with healthy control participants. After ingestion of glucose substrate, breath samples were obtained every 15 min for 2 h. An increase in breath hydrogen or methane above 12 ppm was considered diagnostic of SIBO.
Results:
Overall, 83 participants were tested, of whom 56 were taking PPIs. SIBO was detected in five (8.9%) of the 56 participants taking PPI versus one (3.7%) of the 27 participants in the control group (P=0.359), with a relative risk of 2.4 (95% confidence interval: 0.29-19.6).
Conclusion:
To our knowledge, this is the first study in the English literature measuring the risk of SIBO in children taking PPIs. Our results indicate a potential risk of SIBO in chronic PPI users; however, this is not statistically significant. This is an important finding as PPIs are readily prescribed for children and are often taken longer than 6 months' duration.
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