[Proton Pump Inhibitors and their Microbiome-Mediated Side Effects]

Area of Science:

• Gastroenterology
• Microbiology
• Immunology

Background:

• Proton pump inhibitors (PPIs) effectively treat acid-related disorders by inhibiting gastric acid secretion.
• Reduced gastric acid compromises the natural defense against ingested pathogens.
• The gastric barrier is crucial for protecting the intestinal microbiome from oral bacteria and food-borne pathogens.

Purpose of the Study:

• To investigate the impact of proton pump inhibitors on the intestinal microbiome.
• To explore the link between PPI-induced microbiome alterations and potential side effects.
• To assess the clinical relevance of these changes, particularly in liver cirrhosis patients.

Main Methods:

• Review of existing literature on PPIs and their effects on gastric acid and the microbiome.
• Analysis of studies linking microbiome changes to PPI therapy side effects.
• Examination of data on oral bacteria in the gut and its association with liver disease severity.

Main Results:

• PPIs reduce gastric acid, impairing a key component of the innate immune system.
• Alterations in the intestinal microbiome, including reduced diversity and bacterial overgrowth, are associated with PPI use.
• Increased oral bacteria in the gut of liver cirrhosis patients correlate with inflammation, permeability, and mortality risk.

Conclusions:

• PPI therapy can lead to microbiome-mediated side effects, such as increased susceptibility to infections like Clostridium difficile.
• PPI-induced changes in gut bacteria may contribute to gastrointestinal discomfort and other adverse events.
• Microbiome-mediated effects should be integrated into the risk-benefit assessment of PPIs and the development of alternative treatments.