Proton Pump Inhibitors. Investigating Their Role in Small Intestinal Bacterial Overgrowth
DOI:
https://doi.org/10.12775/QS.2024.20.54123Keywords
proton pump inhibitors, PPI, small intestinal bacterial overgrowth, SIBOAbstract
Proton pump inhibitors (PPIs) are widely used medications known for their effectiveness in reducing gastric acid production and their overall safety profile. Despite being valued for these properties, concerns have been raised regarding potential adverse effects associated with their long-term use. Various studies indicate a higher prevalence of small intestinal bacterial overgrowth (SIBO) in patients on prolonged PPI therapy, with symptoms ranging from bloating and diarrhea to malabsorption and nutrient deficiencies. Diagnosing SIBO primarily involves non-invasive breath tests that measure hydrogen and methane levels produced by bacterial fermentation after ingesting a carbohydrate substrate, such as lactulose or glucose. Direct aspiration and culture of small intestinal fluid offer a more definitive diagnosis but are invasive and less commonly performed. Treatment of SIBO focuses on reducing bacterial overgrowth by using antibiotics.
This review aims to inform clinicians about the possible risks of PPI therapy and the importance of suspecting SIBO in patients with nonspecific gastrointestinal symptoms.
References
Engevik, A. C., Kaji, I., & Goldenring, J. R. (2020). The Physiology of the Gastric Parietal Cell. Physiological reviews, 100(2), 573–602. https://doi.org/10.1152/physrev.00016.2019
Di Mario, F., & Goni, E. (2014). Gastric acid secretion: changes during a century. Best practice & research. Clinical gastroenterology, 28(6), 953–965. https://doi.org/10.1016/j.bpg.2014.10.006
Welage L. S. (2003). Pharmacologic properties of proton pump inhibitors. Pharmacotherapy, 23(10 Pt 2), 74S–80S. https://doi.org/10.1592/phco.23.13.74s.31929
Yao, X., & Smolka, A. J. (2019). Gastric Parietal Cell Physiology and Helicobacter pylori-Induced Disease. Gastroenterology, 156(8), 2158–2173. https://doi.org/10.1053/j.gastro.2019.02.036
Targownik, L. E., Fisher, D. A., & Saini, S. D. (2022). AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology, 162(4), 1334–1342. https://doi.org/10.1053/j.gastro.2021.12.247
Shanika, L. G. T., Reynolds, A., Pattison, S., & Braund, R. (2023). Proton pump inhibitor use: systematic review of global trends and practices. European journal of clinical pharmacology, 79(9), 1159–1172. https://doi.org/10.1007/s00228-023-03534-z
Strand, D. S., Kim, D., & Peura, D. A. (2017). 25 Years of Proton Pump Inhibitors: A Comprehensive Review. Gut and liver, 11(1), 27–37. https://doi.org/10.5009/gnl15502
Schnoll-Sussman, F., Niec, R., & Katz, P. O. (2020). Proton Pump Inhibitors: The Good, Bad, and Ugly. Gastrointestinal endoscopy clinics of North America, 30(2), 239–251. https://doi.org/10.1016/j.giec.2019.12.005
Srebro, J., Brniak, W., & Mendyk, A. (2022). Formulation of Dosage Forms with Proton Pump Inhibitors: State of the Art, Challenges and Future Perspectives. Pharmaceutics, 14(10), 2043. https://doi.org/10.3390/pharmaceutics14102043
Spechler S. J. (2019). Proton Pump Inhibitors: What the Internist Needs to Know. The Medical clinics of North America, 103(1), 1–14. https://doi.org/10.1016/j.mcna.2018.08.001
Forgacs, I., & Loganayagam, A. (2008). Overprescribing proton pump inhibitors. BMJ (Clinical research ed.), 336(7634), 2–3. https://doi.org/10.1136/bmj.39406.449456.BE
Castellana, C., Pecere, S., Furnari, M., Telese, A., Matteo, M. V., Haidry, R., & Eusebi, L. H. (2021). Side effects of long-term use of proton pump inhibitors: practical considerations. Polish archives of internal medicine, 131(6), 541–549. https://doi.org/10.20452/pamw.15997
Haastrup, P. F., Thompson, W., Søndergaard, J., & Jarbøl, D. E. (2018). Side Effects of Long-Term Proton Pump Inhibitor Use: A Review. Basic & clinical pharmacology & toxicology, 123(2), 114–121. https://doi.org/10.1111/bcpt.13023
Skrzydło-Radomańska, B., & Cukrowska, B. (2022). How to Recognize and Treat Small Intestinal Bacterial Overgrowth?. Journal of clinical medicine, 11(20), 6017. https://doi.org/10.3390/jcm11206017
Bushyhead, D., & Quigley, E. M. (2021). Small Intestinal Bacterial Overgrowth. Gastroenterology clinics of North America, 50(2), 463–474. https://doi.org/10.1016/j.gtc.2021.02.008
Rao, S. S. C., & Bhagatwala, J. (2019). Small Intestinal Bacterial Overgrowth: Clinical Features and Therapeutic Management. Clinical and translational gastroenterology, 10(10), e00078. https://doi.org/10.14309/ctg.0000000000000078
Quigley E. M. M. (2019). The Spectrum of Small Intestinal Bacterial Overgrowth (SIBO). Current gastroenterology reports, 21(1), 3. https://doi.org/10.1007/s11894-019-0671-z
Gatta, L., & Scarpignato, C. (2017). Systematic review with meta-analysis: rifaximin is effective and safe for the treatment of small intestine bacterial overgrowth. Alimentary pharmacology & therapeutics, 45(5), 604–616. https://doi.org/10.1111/apt.13928
Rezaie, A., Pimentel, M., & Rao, S. S. (2016). How to Test and Treat Small Intestinal Bacterial Overgrowth: an Evidence-Based Approach. Current gastroenterology reports, 18(2), 8. https://doi.org/10.1007/s11894-015-0482-9
Ponziani, F. R., Gerardi, V., & Gasbarrini, A. (2016). Diagnosis and treatment of small intestinal bacterial overgrowth. Expert review of gastroenterology & hepatology, 10(2), 215–227. https://doi.org/10.1586/17474124.2016.1110017
Pimentel, M., Saad, R. J., Long, M. D., & Rao, S. S. C. (2020). ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. The American journal of gastroenterology, 115(2), 165–178. https://doi.org/10.14309/ajg.0000000000000501
Lauritano, E. C., Gabrielli, M., Scarpellini, E., Ojetti, V., Roccarina, D., Villita, A., Fiore, E., Flore, R., Santoliquido, A., Tondi, P., Gasbarrini, G., Ghirlanda, G., & Gasbarrini, A. (2009). Antibiotic therapy in small intestinal bacterial overgrowth: rifaximin versus metronidazole. European review for medical and pharmacological sciences, 13(2), 111–116.
Zhong, C., Qu, C., Wang, B., Liang, S., & Zeng, B. (2017). Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence. Journal of clinical gastroenterology, 51(4), 300–311. https://doi.org/10.1097/MCG.0000000000000814
Weitsman, S., Celly, S., Leite, G., Mathur, R., Sedighi, R., Barlow, G. M., Morales, W., Sanchez, M., Parodi, G., Villanueva-Millan, M. J., Rezaie, A., & Pimentel, M. (2022). Effects of Proton Pump Inhibitors on the Small Bowel and Stool Microbiomes. Digestive diseases and sciences, 67(1), 224–232. https://doi.org/10.1007/s10620-021-06857-y
Fujimori S. (2015). What are the effects of proton pump inhibitors on the small intestine?. World journal of gastroenterology, 21(22), 6817–6819. https://doi.org/10.3748/wjg.v21.i22.6817
Su, T., Lai, S., Lee, A., He, X., & Chen, S. (2018). Meta-analysis: proton pump inhibitors moderately increase the risk of small intestinal bacterial overgrowth. Journal of gastroenterology, 53(1), 27–36. https://doi.org/10.1007/s00535-017-1371-9
Ratuapli, S. K., Ellington, T. G., O'Neill, M. T., Umar, S. B., Harris, L. A., Foxx-Orenstein, A. E., Burdick, G. E., Dibaise, J. K., Lacy, B. E., & Crowell, M. D. (2012). Proton pump inhibitor therapy use does not predispose to small intestinal bacterial overgrowth. The American journal of gastroenterology, 107(5), 730–735. https://doi.org/10.1038/ajg.2012.4
Jacobs, C., Coss Adame, E., Attaluri, A., Valestin, J., & Rao, S. S. (2013). Dysmotility and proton pump inhibitor use are independent risk factors for small intestinal bacterial and/or fungal overgrowth. Alimentary pharmacology & therapeutics, 37(11), 1103–1111. https://doi.org/10.1111/apt.12304
Compare, D., Pica, L., Rocco, A., De Giorgi, F., Cuomo, R., Sarnelli, G., Romano, M., & Nardone, G. (2011). Effects of long-term PPI treatment on producing bowel symptoms and SIBO. European journal of clinical investigation, 41(4), 380–386. https://doi.org/10.1111/j.1365-2362.2010.02419.x
Lombardo, L., Foti, M., Ruggia, O., & Chiecchio, A. (2010). Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 8(6), 504–508. https://doi.org/10.1016/j.cgh.2009.12.022
Lo, W. K., & Chan, W. W. (2013). Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth: a meta-analysis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 11(5), 483–490. https://doi.org/10.1016/j.cgh.2012.12.011
Revaiah, P. C., Kochhar, R., Rana, S. V., Berry, N., Ashat, M., Dhaka, N., Rami Reddy, Y., & Sinha, S. K. (2018). Risk of small intestinal bacterial overgrowth in patients receiving proton pump inhibitors versus proton pump inhibitors plus prokinetics. JGH open : an open access journal of gastroenterology and hepatology, 2(2), 47–53. https://doi.org/10.1002/jgh3.12045
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Copyright (c) 2024 Adrian Kruszewski, Monika Szyszka, Maja Kucharska, Paulina Przybysz, Kacper Kwiliński, Barbara Wawrzyńska, Natalia Rydlakowska-Orozco
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