Proton Pump Inhibitor Initiation and Withdrawal affects Gut Microbiota and Readmission Risk in Cirrhosis

Area of Science:

• Gastroenterology
• Microbiology
• Clinical Medicine

Background:

• Cirrhosis is characterized by gut microbial dysbiosis, increased hospital readmissions, and frequent overuse of proton pump inhibitors (PPIs).
• The interplay between PPI use, gut microbiota alterations, and readmission risk in cirrhosis patients remains incompletely understood.

Purpose of the Study:

• To investigate the impact of proton pump inhibitor (PPI) use, initiation, and withdrawal on gut microbiota composition and hospital readmission rates in patients with cirrhosis.

Main Methods:

• Analysis of four cohorts: readmissions study (inpatients), cross-sectional microbiota study (outpatients and controls), and two longitudinal studies (decompensated outpatients).
• PPI initiation, withdrawal, and continuation patterns were assessed in relation to readmissions.
• Stool microbiota analysis, focusing on autochthonous and oral-origin taxa, was performed before and after PPI intervention (initiation or withdrawal).

Main Results:

• PPI use was associated with significantly higher 30-day and 90-day readmissions in cirrhotic inpatients, independent of other factors.
• PPI users, irrespective of cirrhosis, exhibited increased oral-origin microbiota, while cirrhotic patients on PPIs showed reduced beneficial autochthonous gut bacteria.
• Omeprazole initiation in cirrhotic outpatients increased oral-origin taxa, whereas PPI withdrawal led to a significant reduction in these taxa.

Conclusions:

• Proton pump inhibitors (PPIs) demonstrably influence readmission risk and gut microbiota composition in cirrhosis.
• The observed changes in microbiota composition are responsive to PPI withdrawal.
• Judicious use and systematic withdrawal of PPIs are recommended for clinical and microbiological management in decompensated cirrhosis.