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Increased incidence of small intestinal bacterial overgrowth during Proton Pump Inhibitor therapy.

Clin Gastroenterol Hepatol. 2010 Jan 5;

Authors: Lombardo L, Foti M, Ruggia O, Chiecchio A

BACKGROUND & AIMS:: Proton pump inhibitors (PPIs) can cause diarrhea and enteric infections and alter the gastrointestinal bacterial population by suppressing the gastric acid barrier. Among patients that received long-term PPI treatment, we evaluated the incidence of small intestinal bacterial overgrowth (SIBO; assessed by glucose hydrogen breath test [GHBT]), the risk factors for development of PPI-related SIBO and its clinical manifestations, and the eradication rate of SIBO after treatment with rifaximin. METHODS:: GHBTs were given to 450 consecutive patients (200 with gastroesophageal reflux disease that received PPIs for a median of 36 months; 200 with irritable bowel syndrome, in absence of PPI treatment, for at least 3 years; and 50 healthy controls that had not received PPI for at least 10 years). Each subject was given a symptoms questionnaire. RESULTS:: SIBO was detected in 50% of patients on PPIs, 24.5% of patients with IBS, and 6% of healthy controls; there was a statistically significant difference between patients on PPIs and those with IBS or healthy controls (p<0.001). The prevalence of SIBO increased after 1 year of treatment with PPI. Bloating and weight loss were more frequent among patients with PPI-related SIBO than those with IBS-related SIBO. The eradication rate of SIBO was 87% in the PPI group and 91% in the IBS group. CONCLUSIONS:: SIBO, assessed by GHBT, occurs significantly more frequently among long-term PPI users than patients with IBS or controls. High-dose therapy with rifaximin eradicated 87%-91% cases of SIBO in patients that continued PPI therapy.

PMID: 20060064 [PubMed - as supplied by publisher]

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