Relationship Between The Proton Pump Inhibitors And Small Intestinal Bacterial Overgrowth

Background:The proton pump inhibitors(PPI) are potent drugs producing profound suppression of gastric acid secretion, so they are widely used for the treatment of gastroesophageal reflux disease (GERD), infection of Helicobacter pylori, gastrointestinal ulcer and so on. Although PPIs are well tolerated,many patients that received long term PPI treatment complain bloating, abdominal pain, diarrhea and constipation, which are similar with the symptoms of small intestinal bacterial overgrowth (SIBO. Relationship between PPI and SIBO is uncertain so far.Purpose:To observe the effects of long-term PPI treatment on development of bowel symptoms and/or SIBO with lactulose hydrogen breath test (LHBT), and evaluate the prevalence of SIBO in patients with long-term PPI treatment.Methods:60patients with GERD not complaining of bowel symptoms and never take the treatment of PPI were selected as observation group,30healthy volunteers were selected as control group, all subjects underwent LHBT. After8weeks,32patients who took a continuous therapy of PPI were selected from observation group (observation group after therapy), and they took LHBT for another time. The data are then subjected to statistical analysis.Results:1. Before the PPI therapy, SIBO was detected in11.67%of observation group and10.00%in control group. There were no statistically significant differences between two groups.2. After8-week PPI therapy, SIBO was detected in53.12%of32subjects, and it was statistically significantly different with8weeks ago (12.50%).3. The average of the basal values of observation group after therapy is11.85ppm, and8subjects of observation group after therapy were detected over12ppm (25%), only1subject was detected over12ppm before PPI therapy in the observation group after therapy (3.12%), and their average of the basal values is5.34ppm.Conclusions:SIBO, assessed by LHBT occurs significantly more frequently among long-term PPI users than control group, so PPI may cause the incidence of SIBO.