Changes in Gastric and Lung Microflora With Acid Suppression

Abstract

The use of acid suppression has been associated with an increased risk of upper and lower respiratory tract infections in the outpatient setting but the mechanism behind this increased risk is unknown. We hypothesize that this infection risk results from gastric bacterial overgrowth with subsequent seeding of the lungs.OBJECTIVES To determine if acid-suppression use results in gastric bacterial overgrowth, if there are changes in lung microflora associated with the use of acid suppression, and if changes in lung microflora are related to full-column nonacid gastroesophageal reflux. DESIGN, SETTING, AND PARTICIPANTSA 5-year prospective cohort study at a tertiary care center where children ages 1 to 18 years were undergoing bronchoscopy and endoscopy for the evaluation of chronic cough. Acid-suppression use was assessed through questionnaires with confirmation using an electronic medical record review. MAIN OUTCOMES AND MEASURESOur primary outcome was to compare differences in concentration and prevalence of gastric and lung bacteria between patients who were and were not receiving acid-suppression therapy. We compared medians using the Wilcoxon signed rank test and determined prevalence ratios using asymptotic standard errors and 95% confidence intervals. We determined correlations between continuous variables using Pearson correlation coefficients and compared categorical variables using the Fisher exact test.RESULTS Forty-six percent of patients taking acid-suppression medication had gastric bacterial growth compared with 18% of untreated patients (P = .003). Staphylococcus (prevalence ratio, 12.75 [95% CI, 1.72-94.36]), Streptococcus (prevalence ratio, 6.91 [95% CI, 1.64-29.02]), Veillonella (prevalence ratio, 9.56 [95% CI, 1.26-72.67]), Dermabacter (prevalence ratio, 4.78 [95% CI, 1.09-21.02]), and Rothia (prevalence ratio, 6.38 [95% CI, 1.50-27.02]) were found more commonly in the gastric fluid of treated patients. The median bacterial concentration was higher in treated patients than in untreated patients (P = .001). There was no difference in the prevalence (P > .23) of different bacterial genera or the median concentration of total bacteria (P = .85) in the lungs between treated and untreated patients. There were significant positive correlations between proximal nonacid reflux burden and lung concentrations of Bacillus

Small Bowel Bacterial Overgrowth Associated with Persistence of Abdominal Symptoms in Children Treated with a Proton Pump Inhibitor

“…In another study, 46% of children taking acidsuppressors had gastric bacterial growth compared with 18% of untreated patients. 10 We also found changes in the pattern of CH 4 excretion. Our sample size is not large enough to draw firm conclusions.…”

Preoperative Gastroesophageal Reflux Disorder Is Associated With Increased Morbidity in Patients Undergoing Abdominal Surgery

“…A greater rate of renal complications may be explained by concurrent PPI use, which has been linked with both acute (18) and chronic (19) kidney disease. The association between wound complications and GERD may be related to the association between acid suppression and bacterial overgrowth (27) as well as increased clinical infection rate (28); however, most data on this topic relates to enteric infection and bacterial growth. Long-term PPI use has also been linked to B12 deficiency in elderly patients, which may contribute to poor wound healing (29–30) and thus, wound complications in elderly surgical patients.…”

Use of Gastroesophageal Reflux Medications in Premature Infants After NICU Discharge

“…6,7,11,19 Although there remains a role for these medications in documented reflux disease, empirical treatment of infants is not recommended. 6,7 In addition, adverse outcomes such as community-acquired pneumonia, 20 -22 gastroenteritis, 21,23 lower respiratory tract infections, 12 Clostridium difficile infection, 24,25 alterations in lung microflora, 26 and fractures 27,28 have been reported with the use of acidblocking medications.…”