Generally, proton-pump inhibitors (PPIs) have short term benefits for patients with acid-related diseases, including Gastro-Oesophageal Reflux Disease, Gastritis, and Peptic Ulcer Disease with less frequently occurring side effects. However, according to a recent report, PPIs provoke dysbiosis of the small intestinal bacterial flora, exacerbating the nonsteroidal anti-inflammatory drug-induced small intestinal injury. Several meta-analyses and systematic reviews have reported that patients treated with PPIs and post-gastrectomy patients have a higher frequency of small intestinal bacterial overgrowth (SIBO) compared to patients who lack the aforementioned conditions.
Prolonged suppression of gastric acid secretion by proton pump inhibitors (PPIs) may alter the bacterial microbiota of the upper gastrointestinal tract and lead to small bowel bacterial overgrowth (SBBO). Therefore, when attempting to control intestinal bacterial flora with probiotics, prebiotics, fecal microbiota transplantation, etc., the influence of acid suppression therapy, especially PPIs, should not be overlooked.
A similar study evaluated whether long-term PPI treatment is associated with the presence of SBBO as determined by breath hydrogen (H2) and methane (CH4) excretion. The differences in H2/CH4 excretion patterns in patients taking PPI compared with those not taking the medication were assessed and searched for the potential predictors of a positive breath test result. Long-term PPI use was significantly associated with SBBO development as determined by breath H2 and CH4 excretion. In addition, CH4 determination reduces the number of falsely negative test results.
Moreover, the researchers found a correlation between the duration of PPI treatment and the detection of SIBO, with more than 70% of the PPI group testing positive for SIBO after 13 months of PPI use—more than triple the proportion of positives among those taking PPIs for a year or less.
According to a published study, IBS patients not taking PPIs and GERD patients on PPIs have roughly equal rates of SIBO, as assessed by lactulose breath tests. However, in that study, the duration of PPI treatment was not clearly stated, but another study showed that PPI treatment increased the incidence of SIBO drastically after the first year.
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