Proton pump inhibitor use associated with changes in gut microbiota composition

Reveles, Kelly R.; Ryan, Caitlin N.; Chan, Luisa; Cosimi, Reese A; Haynes, Wanda L

doi:10.1136/gutjnl-2017-315306

Cited by 42 publications

(44 citation statements)

References 9 publications

(12 reference statements)

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“…In a cohort of 24 elderly, healthy individuals, a 14‐day course of omeprazole (20 mg once daily) did not affect faecal bacterial richness or diversity, but significantly reduced the abundance of Lachnospiraceae, Erysipelotrichaceae and Bifidobacteriaceae, while increasing the abundance of Streptococcaceae . Mishiro et al equally observed increased abundance of faecal Streptococcus levels after 4‐weeks of esomeprazole (20 mg once daily) …”

Section: Resultsmentioning

confidence: 99%

Systematic review: the effects of proton pump inhibitors on the microbiome of the digestive tract—evidence from next‐generation sequencing studies

Macke

Schulz

Koletzko

et al. 2020

Aliment Pharmacol Ther

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Background: Proton pump inhibitors (PPI) are widely used to treat acid-related disorders of the upper gastrointestinal tract. However, large observational studies have raised concerns about PPI-associated adverse events. In recent years, data from next-generation sequencing studies suggested that PPIs affect the composition of the intestinal microbiota, while a balanced gut microbiome is essential for maintaining health.Aim: To review the available evidence from next-generation sequencing studies on the effect of PPIs on the intestinal microbiome and to discuss possible implications of PPI-induced dysbiosis in health and disease.Methods: A systematic review was conducted following the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. A PubMed query yielded 197 results. 19 publications met the prespecified eligibility criteria.Results: Twelve observational study cohorts with 708 PPI users and 11 interventional cohorts with 180 PPI users were included in the review. In most studies, PPI treatment did not affect microbiological richness and diversity, but was associated with distinct taxonomic alterations: In the upper gastrointestinal tract, PPI users showed overgrowth of orally derived bacteria, mostly Streptococcaceae (findings based on six independent cohorts with 126 PPI users). In faecal samples, PPIs increased multiple taxa from the orders Bacillales (eg, Staphylococcaceae), Lactobacillales (eg, Enterococcaceae, Lactobacillaceae, Streptococcaceae) and Actinomycetales (eg, Actinomycetaceae, Micrococcaceae), the families Pasteurellaceae and Enterobacteriaceae and the genus Veillonella. Taxa decreased by PPIs include Bifidobacteriaceae, Ruminococcaceae, Lachnospiraceae and Mollicutes (findings in faecal samples based on 19 independent cohorts with 790 PPI users). Conclusion: PPI use is associated with moderate alterations to upper and distal gut microbiota. The available data suggest that PPI-induced hypochlorhydria facilitates colonization of more distal parts of the digestive tract by upper gastrointestinal microbiota. MACKE Et Al 1 | INTRODUC TI ON: G A S TRI C ACID INHIB ITI ON AND ADVER S E EFFEC TS OF PPIS Gastric acid eliminates microorganisms, promotes the digestive process and facilitates the absorption of iron, calcium and vitamin B12. However, gastric acid also contributes to the development of mild and severe gastroduodenal pathologies. Proton pump inhibitor (PPIs) are the most effective therapy of acid-related diseases and are among the most commonly used drugs. 1 While generally considered a safe therapy, PPIs have been associated with numerous adverse effects in population-based observational studies conducted in recent years. These include cardiovascular and kidney disease, micronutrient deficiencies and osteoporosis, cognitive impairment and death. 2Most studies are retrospective and not hypothesis-driven in design, might be subject to significant confound and thus they cannot establish causality. 2,3 This is also the case for a recent study on ...

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Section: Resultsmentioning

confidence: 99%

Systematic review: the effects of proton pump inhibitors on the microbiome of the digestive tract—evidence from next‐generation sequencing studies

Macke

Schulz

Koletzko

et al. 2020

Aliment Pharmacol Ther

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“…Proton pump inhibitors are considered safe and well tolerated and are associated with a low incidence of severe adverse effects . But evidence has revealed that PPIs influence the gut microbiota and potentially increase the risk for enteric infections, notably by increasing the risk for Clostridium difficile infection, which could lead to bacterial translocation . Use of PPIs predisposes to the development of complications associated with decompensated cirrhosis .…”

Section: Introductionmentioning

confidence: 99%

Proton pump inhibitor therapy does not increase serum endotoxin activity in patients with cirrhosis

Okada

Namisaki

Sato

et al. 2018

Hepatology Research

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“…Despite our reasonably extensive understanding of the manner in which antibiotics manipulate the intestinal microbiota, we are only now beginning to recognise the sizeable impact which other commonly prescribed medications have on even the established adult microbiota. Several recent clinical studies have highlighted the effects of proton pump inhibitors on the composition and functionality of the intestinal microbiome [63,64], while metformin has received considerable attention for its potentiating effects on the metabolic health-associated microbe Akkermansia muciniphila [65,66]. The study of a combined Belgian-Dutch cohort of extensively phenotyped participants revealed a far more inclusive list of microbiota-modulating pharmaceuticals, including osmotic laxatives, antidepressants, female hormone therapies and TNF-alpha inhibitors [67].…”

Section: Pharmaceuticals and The Gut Microbiotamentioning

confidence: 99%

The Gut Microbiota: A Clinically Impactful Factor in Patient Health and Disease

Rodríguez

Peña-Vélez

Monjaráz

et al. 2018

SN Compr. Clin. Med.

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The gut microbiota, often referred to as the body's virtual organ, is a complex ecosystem made up of trillions of microorganisms that interact with host physiology in a myriad of ways. This lifelong interaction begins in the early stages of life, and it is subject to alterations exerted by environmental factors, especially those that characterise modern societies such as ultra-processed foods and pharmaceutical interventions, amongst others. These alterations, in turn, carry with them implications for host health and disease. Due to this putative role in human health and the fact that study of the gut microbiota is now rapidly evolving, it is of paramount importance that all clinicians be aware of the most up-to-date literature in this field. Herein, we present a state-of-theart review which aims to outline the most relevant pre-clinical and clinical knowledge around the gut microbiota-host interaction. This review focuses primarily on the development and key functions of the gut microbiota with respect to host health and disease, but also addresses the basic concept of gut dysbiosis.

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Proton pump inhibitor use associated with changes in gut microbiota composition

Cited by 42 publications

References 9 publications

Systematic review: the effects of proton pump inhibitors on the microbiome of the digestive tract—evidence from next‐generation sequencing studies

Systematic review: the effects of proton pump inhibitors on the microbiome of the digestive tract—evidence from next‐generation sequencing studies

Proton pump inhibitor therapy does not increase serum endotoxin activity in patients with cirrhosis

The Gut Microbiota: A Clinically Impactful Factor in Patient Health and Disease

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