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Proton Pump Inhibitors (PPIs) are medications used to treat gastroesophageal reflux disease (GERD). A new study has found a link between the use of PPIs and small intestine bacterial overgrowth (SIBO).

According to the study abstract, the researchers administered hydrogen breath tests (HBTs) to three groups of individuals: 200 GERD patients who had been taking PPIs for an average of three years, 200 IBS patients who had not taken PPIs in the last three years, and 50 healthy control subjects who had not taken a PPI in at least ten years. Participants also took a questionnaire regarding their symptoms.

Of the patients taking PPIs, half of them tested positive for SIBO, as did roughly a quarter of the IBS patients. SIBO was only detected in six percent of the healthy individuals. The risk of having SIBO following PPI use was greater after patients took the medication for a year. The GERD patients who were identified as having SIBO were more likely to experience bloating and weight loss than those IBS patients who tested positive for SIBO.

All of the study participants who tested positively for SIBO were treated with the antibiotic Rifaximin. (A responsible move by the researchers if you ask me). Again, according to the study abstract, treatment was quite successful with SIBO being eradicated in 87% or the GERD patients and 91% of the IBS patients.

Wow, those are some pretty successful treatment results, but I am left with a few questions. Was the positive HBT related to the patients' symptom picture? Did the eradication of the SIBO lead to symptom improvement? Did SIBO return after the treatment ended? These big questions are not just my own - they dominate the debate on the relationship between SIBO and IBS. Whatever the eventual answers are, the link between PPIs and SIBO is an interesting one - one that you might want to discuss with your doctor if you are being treated for GERD alongside your IBS.

Related Reading:


[sub]Lombardo, L., Foti, M., Ruggia, O. & Chieccio, A. "Increased incidence of small intestinal bacterial overgrowth during Proton Pump Inhibitor therapy" Clinical Gastroenterology and Hepatology Published online January 7, 2010.[/sub]

SIBO Following PPI Therapy originally appeared on Irritable Bowel Syndrome on Wednesday, February 10th, 2010 at 10:08:14.

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