Gastric acid reduction leads to an alteration in lower intestinal microflora

Kuriyama, Takayuki; Matsuki, Takahiro; Oka, Masashi; Utsunomiya, Hirotoshi; Inada, Ken‐ichi; Magari, Hirohito; Inoue, Izumi; Maekita, Takao; Ueda, Kazuki; Enomoto, Shotaro; Iguchi, Mikitaka; Yanaoka, Kimihiko; Tamai, Hideyuki; Akimoto, Shigeru; Nomoto, Koji; Tanaka, Ryuichiro; Ichinose, Masakazu

doi:10.1016/j.bbrc.2009.02.109

Cited by 101 publications

(79 citation statements)

References 27 publications

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“…Bacteria in the small and large intestines increase in number in the conditions with decreased gastric acid. 30,31 These medications are commonly prescribed, and there is emerging literature questioning the safety of PPIs. 32,33 Many studies have addressed the association between the risk of CDI and use of acid suppression medications and have found that acid suppression is a risk factor associated with the development of CDI.…”

Section: Discussionmentioning

confidence: 99%

Gastric Acid Suppression and Outcomes in Clostridium difficile Infection: A Population-Based Study

Khanna

Aronson

Kammer

et al. 2012

Mayo Clinic Proceedings

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Objective: To evaluate the association of gastric acid suppression medications, including proton pump inhibitors and histamine type 2 blockers, with outcomes in patients with Clostridium difficile infection (CDI) in a population-based cohort. Patients and Methods: To understand the association between acid suppression and outcomes in patients with CDI, we conducted a population-based study in Olmsted County, Minnesota, from January 1, 1991, through December 31, 2005. We compared demographic data and outcomes, including severe, severe-complicated, and recurrent CDI and treatment failure, in a cohort of patients with CDI who were treated with acid suppression medications with these outcomes in a cohort with CDI that was not exposed to acid-suppressing agents. Results: Of 385 patients with CDI, 36.4% were undergoing acid suppression (23.4% with proton pump inhibitors, 13.5% with histamine type 2 blockers, and 0.5% with both). On univariate analysis, patients taking acid suppression medications were significantly older (69 vs 56 years; PϽ.001) and more likely to have severe (34.2% vs 23.6%; Pϭ.03) or severecomplicated (4.4% vs 2.6% CDI; Pϭ.006) infection than patients not undergoing acid suppression. On multivariable analyses, after adjustment for age and comorbid conditions, acid suppression medication use was not associated with severe or severecomplicated CDI. In addition, no association between acid suppression and treatment failure or CDI recurrence was found. Conclusion: In this population-based study, after adjustment for age and comorbid conditions, patients with CDI who underwent acid suppression were not more likely to experience severe or severe-complicated CDI, treatment failure, or recurrent infection.

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Section: Discussionmentioning

confidence: 99%

Gastric Acid Suppression and Outcomes in Clostridium difficile Infection: A Population-Based Study

Khanna

Aronson

Kammer

et al. 2012

Mayo Clinic Proceedings

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“…Previous studies have indicated that the presence of enteric infection and overgrowth of intestinal bacteria are directly related to a reduction in gastric acid secretion (35)(36)(37). Our previous study demonstrated that CAG-positive asymptomatic middle-aged subjects, as determined by the serum PG levels of PG I ≤70 ng/ml and a PG I/II ratio of ≤3.0, were found to have larger colonic microflora compared to CAG-negative subjects, with an increase in 83% of the genera or groups comprising intestinal microflora (6). Gastric acid reduction is also reported to lead to increases in unabsorbed nutrients in the lower intestine, due to impaired gastric protein digestion (38), therefore leading to the alteration of the microflora with an increase in bacterial species utilizing these malabsorbed nutrients.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies using various non-transformed or transformed cell lines for in vitro and in vivo animal experiments, including transgenic mouse models, have shown that non-amidated gastrins, such as progastrin and glycine-extended gastrin act as growth factors for colonic epithelia and neoplasia, and are potentially involved in colonic carcinogenesis (3)(4)(5). Chronic atrophic gastritis (CAG) and intestinal metaplasia, an end stage of chronic H. pylori infection, induce hypochlorhydria, which leads to bacterial overgrowth in the gastrointestinal tract and to alterations in the colonic microenvironment of the bacterial flora (6). On the basis of these findings, we hypothesized that gastric neoplasia and colorectal neoplasia share a common risk factor with regard to H. pylori infection and the resultant CAG, and demonstrate a significantly elevated risk of colorectal adenoma with the establishment of H. pylori-associated chronic gastritis in a population-based case-control study (7).…”

Section: Introductionmentioning

confidence: 99%

Elevated risk of recurrent colorectal neoplasia with Helicobacter pylori-associated chronic atrophic gastritis: A follow-up study of patients with endoscopically resected colorectal neoplasia

Inoue

Kato

Yoshimura

et al. 2012

Molecular and Clinical Oncology

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Abstract.In a previous population-based case-control study, we demonstrated an elevated risk of colorectal neoplasia with Helicobacter pylori (H. pylori) infection. The present study investigated the effects of H. pylori-associated chronic gastritis on the development of colorectal neoplasia by analyzing the recurrence of colorectal neoplasia subsequent to endoscopic resection. Ninety-nine patients who had undergone endoscopic resection of colorectal neoplasia were monitored under colonoscopy, and the recurrence of colorectal neoplasia was prospectively investigated. The stage of H. pylori-associated chronic gastritis in each subject was evaluated using a combination of two serum tests: H. pylori antibody and pepsinogen. In the present cohort, colorectal neoplasia recurred at a rate of 15,296/100,000 person-years during the study period. After adjusting for the confounding factors, chronic atrophic gastritis (CAG) was identified as an independent risk factor [adjusted hazard ratio (HR), 2.72; 95% confidence interval, 1.33-5.57], while H. pylori-infected non-atrophic gastritis was not identified as an independent risk factor for recurrent colorectal neoplasia. Colorectal neoplasia recurred earlier and was significantly more frequent in patients with CAG (22,573/100,000 person-years) compared to patients without CAG (11,089/100,000 person-years; P=0.029, log-rank test).Patients with more extensive CAG showed a higher risk of recurrence. These results demonstrated a significant elevation of the risk of recurrent colorectal neoplasia with the establishment and progression of CAG, indicating the involvement of H. pylori infection in the development of colorectal neoplasia. The two serum tests were useful clinical markers for noninvasively evaluating the risk of each individual for recurrent colorectal neoplasia subsequent to endoscopic resection.

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“…For quantitative PCR of bacterial 16S rRNA genes, the fecal DNA was subjected to real time quantitative PCR using the SYBR Premix Ex Taq (TaKaRa). The primers were reported previously (32). The quantity of each bacterial DNA was calculated with the standard DNA preparations of each bacterial species.…”

Section: /Atg7mentioning

confidence: 99%

Autophagy Protects against Colitis by the Maintenance of Normal Gut Microflora and Secretion of Mucus

Tsuboi

Nishitani

Takakura

et al. 2015

Journal of Biological Chemistry

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Background:The role of autophagy in colonic homeostasis is not clear. Results: Colonic epithelial cell-specific and autophagy-deficient mice showed exacerbation of colitis and abnormal gut microflora with less abundant antimicrobial peptide production and secretion of mucus. Conclusion: Autophagy protects against colitis by the maintenance of normal gut microflora and secretion of mucus. Significance: These findings may ultimately lead to an efficient intervention for inflammatory bowel diseases.

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Gastric acid reduction leads to an alteration in lower intestinal microflora

Cited by 101 publications

References 27 publications

Gastric Acid Suppression and Outcomes in Clostridium difficile Infection: A Population-Based Study

Gastric Acid Suppression and Outcomes in Clostridium difficile Infection: A Population-Based Study

Elevated risk of recurrent colorectal neoplasia with Helicobacter pylori-associated chronic atrophic gastritis: A follow-up study of patients with endoscopically resected colorectal neoplasia

Autophagy Protects against Colitis by the Maintenance of Normal Gut Microflora and Secretion of Mucus

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