Is It Useful to Administer Probiotics Together With Proton Pump Inhibitors in Children With Gastroesophageal Reflux?

Belei, Oana; Olariu, Laura; Dobrescu, Andreea; Marcovici, Tamara; Mărginean, Otilia

doi:10.5056/jnm17059

Cited by 34 publications

(30 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…So far only one small study addressed the effect of probiotics in children receiving a 12 week treatment with PPI for gastroesophageal reflux. In this study no microbiome sequencing data were presented, but small intestinal bacterial overgrowth (measured with a hydrogen breath test) could be reduced significantly 24 .…”

Section: Discussionmentioning

confidence: 97%

The effects of a multispecies synbiotic on microbiome-related side effects of long-term proton pump inhibitor use: A pilot study

Horvath

Leber

Feldbacher

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Side effects of proton pump inhibitors (PPI) can be linked to the changes in the intestinal microbiome that occur during therapy, especially in long-term users. Therefore, the microbiome might also be a key player in the reduction of PPI side effects. We tested the effects of a three-month intervention with a multispecies synbiotic on intestinal inflammation, gut barrier function, microbiome composition, routine laboratory parameters and quality of life in patients with long-term PPI therapy. Thirtysix patients received a daily dose of a multispecies synbiotic for three months and were clinically observed without intervention for another three months. After intervention 17% of patients reached normal calprotectin levels; the overall reduction did not reach statistical significance (−18.8 ng/ mg; 95%CI: −50.5; 12.9, p = 0.2). Elevated zonulin levels could be significantly reduced (−46.3 ng/ mg; 95%CI: −71.4; −21.2; p < 0.001). The abundance of Stomatobaculum in the microbiome was reduced and Bacillus increased during the intervention. Furthermore, albumin, alkaline phosphatase and thrombocyte count were significantly increased and aspartate transaminase was significantly decreased during intervention. Gastrointestinal quality of life showed significant improvements. In conclusion, microbiome-related side effects of long-term PPI use can be substantially reduced by synbiotic intervention. Further studies are warranted to optimize dosage and duration of the intervention. In the last 30 years proton pump inhibitors (PPI) have established themselves as highly effective treatment of acid related diseases and became the most often prescribed class of drugs in gastroenterology 1,2. Underneath their immaculate image of gastric protection, however, their side effect profile-although well described by high quality data-remained largely unaddressed 3. Many of the side effects might be rooted in PPI-induced changes of the microbiome (i.e. dysbiosis): increased risk of enteric infections, bloating, flatulence, abdominal pain, stool frequency abnormalities, intestinal inflammation and vitamin B12 malabsorption 4-12. Long term PPI use can introduce ample alterations to the intestinal microbiome: Changes in composition, reduction of alpha diversity, small intestinal bacterial overgrowth and the manifestation of oral bacteria in more distal parts of the intestine have been observed 13-19. A loss of alpha diversity and therefore a loss in pathogen-colonization resistance could account for the increased risk of enteric infections 20,21. The change of composition, which includes the reduction of Clostridiales and the increase of Enterococcaceae and Streptococcaceae, and function of the microbiome might directly predispose for Clostridium difficile infections 22. In children, persistent bowel symptoms during PPI use have been linked to small intestinal bacterial overgrowth 23. The association with the microbiome could be a crucial factor for the amelioration of PPI side effects. Modulating the microbiome with probiotic bacteria might ...

show abstract

Section: Discussionmentioning

confidence: 97%

The effects of a multispecies synbiotic on microbiome-related side effects of long-term proton pump inhibitor use: A pilot study

Horvath

Leber

Feldbacher

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…After 12 weeks of treatment with a proton pump inhibitor, dysbiosis was diagnosed according to the results of a glucose hydrogen breath test in 56.2% of the children in the placebo group, compared to 6.2% of the children in the probiotic group (P < 0.001) [72]. Bacterial overgrowth was detected in 5% of controls, which is similar to the group treated with L. reuteri and proton pump inhibitors [72].…”

Section: Probiotics and Prevention Of Regurgitationmentioning

confidence: 73%

Probiotics as prevention for gastro-intestinal disorders in pediatrics.

Perceval¹,

Pletincx²,

Vandenplas³

2019

View full text Add to dashboard Cite

This is a narrative review, largely of randomized trials on the impacts of probiotics. It concludes that evidence for beneficial effects of selected probiotics in the prevention of gastrointestinal disorders is limited mainly to acute gastroenteritis, antibiotic-associated diarrhea, infantile colic and necrotizing enterocolitis. However, there is no broad consensus to recommend the use of probiotics in the prevention of these conditions, mainly because of the different designs used in different studies, resulting in limited evidence for specific strains, dosages and indications. More well-designed studies utilizing standardized methodologies are needed before recommendations can be proposed. At this stage, there is insufficient evidence to recommend the routine use of probiotics in infants and children for the prevention of gastro-intestinal disorders.

show abstract

“…In a clinical study on patients with functional dyspepsia, Tsuda et al[25] found that 4 wk of PPI use caused SIBO. Oana et al[26] conducted a clinical trial on pediatric gastroesophageal reflux disease (GERD) patients administered probiotics and PPI for 12 wk and found that probiotics administration decreased the rate of dysbiosis in children treated with PPI. Jacobs C et al[27] conducted a study focusing on the risk factors of SIBO.…”

Section: Discussionmentioning

confidence: 99%

Beneficial effect of probiotics supplements in reflux esophagitis treated with esomeprazole: A randomized controlled trial

Sun

Wang

Sun

et al. 2019

WJG

View full text Add to dashboard Cite

BACKGROUND Reflux esophagitis (RE) is a common digestive disorder, and its frequent recurrences cause significant physical pain and are financially burdensome to patients. However, studies on the natural history of treated RE are few. Although proton pump inhibitors (PPIs) as the first-line treatment provide notable symptomatic relief, disordered gut microbiota has been observed among PPI users. Probiotics are commonly administered to patients to regulate the disordered intestinal flora. AIM To evaluate the therapeutic effects in RE patients treated with a combination of esomeprazole and probiotics [ Bacillus subtilis ( B. subtilis ) and Enterococcus faecium ( E. faecium )]. METHODS One hundred and thirty-four RE patients were randomized into two groups of 67 subjects each. The probiotics group was administered with esomeprazole 20 mg b.i.d . and live combined B. subtilis and E. faecium enteric-coated capsules 500 mg t.i.d . for eight weeks; the placebo group was administered with esomeprazole 20 mg b.i.d . and placebo for eight weeks. Subsequently, 12-wk follow-up was carried out on patients who achieved both endoscopic and clinical cure. Endoscopy, reflux diagnostic questionnaire (RDQ), gastrointestinal symptom rating scale (GSRS), and lactulose hydrogen breath test were performed to evaluate the therapeutic effects. A difference of P < 0.05 was considered statistically significant. RESULTS Sixty-six patients in the probiotics group and 64 patients in the placebo group completed the 8-wk treatment. The healing rate and RDQ score had no significant difference between the two groups ( P > 0.05). However, the GSRS diarrhea syndrome score was decreased significantly in the probiotics group ( P = 0.002), and the small intestinal bacterial overgrowth negative rate in the probiotics group was significantly higher than that in the placebo group ( P = 0.002). Of 114 endoscopically and clinically cured patients, 96 completed the follow-up. The log-rank test showed that the time to relapse was shorter in the placebo group than in the probiotics group ( P = 0.041). Furthermore, the therapy had a significant influence on relapse time, and the risk of relapse in the probiotics group was lower than that in the placebo group at any time point during the 12-wk follow-up (hazard ratio = 0.52, P = 0.033). CONCLUSION Esomeprazole combined with probiotics ( B. subtilis and E. faecium ) have a beneficial effect on RE treatment and patient management. ...

show abstract

Is It Useful to Administer Probiotics Together With Proton Pump Inhibitors in Children With Gastroesophageal Reflux?

Cited by 34 publications

References 25 publications

The effects of a multispecies synbiotic on microbiome-related side effects of long-term proton pump inhibitor use: A pilot study

The effects of a multispecies synbiotic on microbiome-related side effects of long-term proton pump inhibitor use: A pilot study

Probiotics as prevention for gastro-intestinal disorders in pediatrics.

Beneficial effect of probiotics supplements in reflux esophagitis treated with esomeprazole: A randomized controlled trial

Contact Info

Product

Resources

About