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Longitudinal Microbiome Changes in Children Exposed to Proton Pump Inhibitors
Yanjia Jason Zhang1,2, Sarah Connearney1, Lisa Hester1
1Gastroenterology/Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Proton pump inhibitor (PPI) use alters the gut microbiome in children, increasing Streptococcus and oropharyngeal bacteria in stool. This study tracked microbiome changes before and after PPI therapy in pediatric patients.
Area of Science:
- Microbiology
- Pediatric Gastroenterology
- Microbiome Research
Background:
- Proton pump inhibitors (PPIs) are linked to infections in children.
- Limited longitudinal data exist on PPI effects in pediatric populations.
- Understanding PPI-induced microbiome alterations is crucial for pediatric health.
Purpose of the Study:
- To prospectively compare the stool and oropharyngeal microbiome in children before and after initiating PPI therapy.
- To identify specific microbial taxa affected by PPI use in children.
- To investigate age-related susceptibility to PPI-induced microbiome changes.
Main Methods:
- Prospective observational study design.
- Recruitment from a pediatric gastroenterology clinic.
- Collection of stool and oropharyngeal samples at baseline and 8 weeks post-PPI initiation.
- 16S rRNA gene sequencing for microbiome analysis.
Main Results:
- No significant changes in overall microbial community structure (beta-diversity) in stool or oropharynx.
- Significant alterations in specific bacterial taxa, including enrichment of Streptococcus in stool.
- Reduction in the relative abundance of Bifidobacterium, Peptostreptococcus, and Turicibacter in stool.
- Increased relative abundance of oropharyngeal bacteria in stool samples post-PPI therapy, particularly in younger children.
Conclusions:
- PPI therapy significantly alters the pediatric microbiome composition, despite no change in overall diversity.
- The enrichment of oropharyngeal bacteria in stool suggests potential for altered microbial translocation or colonization.
- Younger children appear more susceptible to PPI-induced microbiome alterations, warranting further investigation into clinical and microbial factors.
Introduction:
Proton pump inhibitor (PPI) use has been associated with an increased risk of gastrointestinal and upper respiratory infections in children. There are limited longitudinal data on the effect of PPI in children. The goal of this prospective observational study was to compare the stool and oropharyngeal microbiome of children before and after starting PPIs.
Methods:
We prospectively recruited participants from a gastroenterology clinic. Consented participants provided stool samples and oropharyngeal swabs at baseline and after 8 weeks of PPI therapy. Microbiome changes were measured by analyzing 16S sequencing from both body sites at both time points.
Results:
Thirty-four participants completed the study and provided samples both at baseline and after 8 weeks on PPI therapy. Of those, 24 participants had sufficient sequencing from both stool and oropharyngeal samples at both time points. There were no differences between the pre-PPI and post-PPI samples using beta-diversity metrics in either the oropharynx or stool. There were, however, significant changes in specific taxa. There was an enrichment of Streptococcus in the stool after PPI use and a reduction in the relative abundance of Bifidobacterium , Peptostreptococcus , and Turicibacter ( P -values < 0.01). Furthermore, there was an increase in the relative abundance of oropharyngeal bacteria in the stool after PPI therapy. This enrichment of oropharyngeal bacteria in the stool was most prominent in younger participants.
Discussion:
Further investigation is needed to determine the clinical and microbial factors that predispose or protect against microbiome changes due to PPI use and why young children are more susceptible to this PPI effect.
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