Gut Microbiota Characteristics in Children After the Use of Proton Pump Inhibitors

Simakachorn, Lila; Tanpowpong, Pornthep; Chanprasertyothin, Suwannee; Thongpradit, Supranee; Treepongkaruna, Suporn

doi:10.5152/tjg.2020.20245

Cited by 5 publications

(7 citation statements)

References 21 publications

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“…A trial with 14 participants showed that a month-long treatment course with PPIs was not associated with a change in diversity of microbiota 16. Similarly, a recent observational study that enrolled 20 children found no significant change in the total number of predominant gut microbiota after a 4 to 8 weeks’ course of PPI treatment 17. These data suggest that our observed associations during the risk period are unlikely to be biologically plausible, at least if the putative mechanism is alteration of the microbiome.…”

Section: Discussionmentioning

confidence: 98%

Association between proton pump inhibitor use and risk of pneumonia in children: nationwide self-controlled case series study in Sweden

et al. 2022

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ObjectiveTo evaluate the association between use of proton pump inhibitors (PPIs) and risk of pneumonia in children.DesignNationwide register-based self-controlled case series study.SettingSweden, July 2006 to December 2016.ParticipantsChildren aged <18 years who were treated with PPIs and had a hospitalisation or hospital emergency care visit for pneumonia within 1 year before and 2 years after PPI initiation.Main outcomes and measuresThe primary analysis examined the risk of pneumonia during the risk period (ongoing PPI treatment), the pre-exposure period (≤30 days preceding PPI treatment) and the postexposure period (days 1–365 after PPI discontinuation), comparing to the unexposed period. Conditional Poisson regression was used to estimate incidence rate ratios (IRRs) and 95% CIs.ResultsA total of 2356 cases of pneumonia were included. Compared with the unexposed period, the risk of pneumonia was significantly increased during ongoing PPI treatment, with an adjusted IRR of 1.40 (95% CI 1.21 to 1.62). The risk of pneumonia was also increased in the pre-exposure period (adjusted IRR, 1.80, 95% CI 1.51 to 2.13), but not in the postexposure period (adjusted IRR 0.98, 95% CI 0.89 to 1.08). Dividing the risk period by time since treatment initiation, the increased risk of pneumonia was highest in the first 30 days (adjusted IRR 1.63, 95% CI 1.35 to 1.97), remained during days 31–90 (adjusted IRR 1.32, 95% CI 1.04 to 1.69), but waned in days ≥91 (IRR 1.06, 95% CI 0.79 to 1.41).Conclusions and relevanceAn increased risk of pneumonia was observed both immediately before and immediately after PPI initiation. This pattern of association can likely be explained by an underlying risk of pneumonia due to factors transiently present at the time around PPI initiation. Thus, our findings do not support a causal relationship between PPI use and risk of pneumonia.

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Section: Discussionmentioning

confidence: 98%

Association between proton pump inhibitor use and risk of pneumonia in children: nationwide self-controlled case series study in Sweden

et al. 2022

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“…Direct evidence on the effect of PPIs on the microbiome in children remains limited [ 29 ], with two studies based on 16 s rRNA sequencing including (some) small children [ 54 , 55 ]. One study followed 12 infants with confirmed gastro-esophageal reflux, exposed to oral PPIs for 8–44 weeks [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

“…From adult studies, we know that PPIs may have the most significant impact on the fecal microbiome composition on a population level, even larger than antibiotics which are rarely used for such a prolonged duration; and that PPIs may affect the microbiome throughout the gastrointestinal tract [ 44 – 47 ]. We also know that antibiotic exposure during early life affects the microbiome composition [ 48 – 53 ], yet only a few studies looked into the effect of PPIs on the early gut microbiome [ 29 , 54 , 55 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of proton pump inhibitors in infants with esophageal atresia on the gut microbiome: a pilot cohort

et al. 2022

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Background The effects of proton-pump inhibitors (PPIs) on the infant microbiome remain unclear. Swedish pilot cohort study to assess the longitudinal effect of long-term PPI on the infant gut microbiome, including ten newborn infants operated for esophageal atresia exposed to PPIs (mean 57 weeks), compared to healthy one-year-old controls. All children were born vaginally and were otherwise healthy. Within- and between sample diversity of the fecal microbiome was assessed using untargeted whole genome Shotgun metagenomics which sequences all the DNA in the sample and can capture genes rather than a taxonomic fingerprint. Results A longer duration of PPI-use was associated with considerable changes in evenness and high variation on diversity within samples compared to a shorter duration of use. The limited difference between baseline samples and controls suggests that this shift was most likely due to the drug exposure and not the underlying alterations on the microbiome. We found no associations with the number of antibiotic treatment episodes among the PPI-users. Conclusion Prolonged PPI-use may alter the early infant gut microbiome composition, especially those with the most prolonged duration of use.

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“…A trend toward reduced diversity was also reported in some reports, even if not always significant [ 44 , 45 ]. Other studies showed no major changes in diversity [ 46 , 47 , 48 ].…”

Section: Protonic Pump Inhibitorsmentioning

confidence: 97%

“…PPIs are prodrugs that need to be activated by addition of two protons and, once they are activated, they can inactivate the proton pump by binding to the H+-K+-ATPase that normally creates a 1 million-fold gradient in H+ concentration from inside the parietal cell to the gastric lumen in return for inward transport of K+ [ 143 ]. A first report on 20 children treated with PPI found no significant changes in overall number of species-level taxonomy categories but with an increase in the phylum Firmicutes in some subgroups [ 48 ]. Other studies demonstrated that PPI use is associated with an altered composition of the GM, with an increase in the Lactobacillales order and in particular the family Streptococcaceae , which has been associated with increased risk for C. difficile infection (CDI) [ 43 , 44 , 45 , 46 , 144 ].…”

Section: Protonic Pump Inhibitorsmentioning

confidence: 99%

Pharmacomicrobiomics in Pediatric Oncology: The Complex Interplay between Commonly Used Drugs and Gut Microbiome

Leardini¹,

Venturelli

Baccelli³

et al. 2022

IJMS

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The gut microbiome (GM) has emerged in the last few years as a main character in several diseases. In pediatric oncological patients, GM has a role in promoting the disease, modulating the effectiveness of therapies, and determining the clinical outcomes. The therapeutic course for most pediatric cancer influences the GM due to dietary modifications and several administrated drugs, including chemotherapies, antibiotics and immunosuppressants. Interestingly, increasing evidence is uncovering a role of the GM on drug pharmacokinetics and pharmacodynamics, defining a bidirectional relationship. Indeed, the pediatric setting presents some contrasts with respect to the adult, since the GM undergoes a constant multifactorial evolution during childhood following external stimuli (such as diet modification during weaning). In this review, we aim to summarize the available evidence of pharmacomicrobiomics in pediatric oncology.

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Gut Microbiota Characteristics in Children After the Use of Proton Pump Inhibitors

Cited by 5 publications

References 21 publications

Association between proton pump inhibitor use and risk of pneumonia in children: nationwide self-controlled case series study in Sweden

Association between proton pump inhibitor use and risk of pneumonia in children: nationwide self-controlled case series study in Sweden

Effect of proton pump inhibitors in infants with esophageal atresia on the gut microbiome: a pilot cohort

Pharmacomicrobiomics in Pediatric Oncology: The Complex Interplay between Commonly Used Drugs and Gut Microbiome

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