title: Correlation between chronic treatment with proton pump inhibitors and bacterial overgrowth in the stomach: any possible beneficial role for selected lactobacilli?
abstract: BACKGROUND
  The inhibition of physiological gastric acid secretion induced by proton pump inhibitors (PPIs), the most widely used drugs in the world, may cause a significant bacterial overgrowth in the gastrointestinal tract as a side effect. This study was undertaken firstly to correlate PPI intake with concentration of specific bacterial groups in the stomach as well as possible Helicobacter pylori infection, and secondly to assess the efficacy of the 4 lactobacilli L. rhamnosus LR06 (DSM 21981), L. pentosus LPS01 (DSM 21980), L. plantarum LP01 (LMG P-21021), and L. delbrueckii subsp. delbrueckii LDD01 (DSM 22106) in the restoration of a physiological gastric barrier.
  
  
  METHODS
  Total bacteria, sulphite-reducing bacteria (SRB), total coliforms, and total lactobacilli were quantified in samples of gastric juice from 29 subjects taking PPIs for at least 3 months compared with 36 control subjects. The presence of H. pylori was also assessed.The subjects treated with PPIs with a concentration of total bacteria in the gastric juice higher than 10(5) cells/mL were selected for an intervention study with the 4 lactobacilli L. rhamnosus LR06, L. pentosus LPS01, L. plantarum LP01, and L. delbrueckii subsp. delbrueckii LDD01. After 15 days of supplementation, the same bacterial groups were quantified to compare these values with the baseline.
  
  
  RESULTS
  No significant correlation was found between the presence of H. pylori and PPI intake. The baseline quantification of bacterial groups (log10 CFU/mL of gastric juice, PPI group vs. control) showed: total bacteria 8.35 versus 3.95 (P<0.001); total coliforms 4.98 versus 2.35 (P<0.001); SRB 5.71 versus 2.28 (P=0.065); and total lactobacilli 3.85 versus 2.20 (P=0.005). After 15 days of treatment with the 4 lactobacilli, the quantification of bacterial groups gave the following results: total bacteria 7.91 versus 8.35 at time zero (P=0.002); total coliforms 4.21 versus 4.98 at time zero (P<0.001); SRB 4.94 versus 5.71 at baseline (P=0.060); and total lactobacilli 7.20 versus 3.85 at baseline (P=0.040).
  
  
  CONCLUSIONS
  A significant impairment of intragastric acidity is sufficient to induce a relevant bacterial overgrowth, with particular reference to SRB and total coliforms. This fact can contribute to an increase in the risk of infections and intestinal diseases. It could be crucial to restore the physiological "gastric barrier." The 2-week supplementation with the 4 lactobacilli tested proved to be effective in significantly reducing total bacteria and coliforms in the gastric milieu in subjects chronically treated with PPIs. It is therefore possible to hopothesise a beneficial role for such lactobacilli in clinical practice.
authors.affiliation: *Gastroenterology Unit, Maggiore della Carità Hospital †Biolab Research Ltd., Novara, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Del Piano
authors.forename: Michela
authors.initials: M
authors.lastname: Pagliarulo
authors.forename: Roberto
authors.initials: R
authors.lastname: Tari
authors.forename: Stefania
authors.initials: S
authors.lastname: Carmagnola
authors.forename: Marco
authors.initials: M
authors.lastname: Balzarini
authors.forename: Paola
authors.initials: P
authors.lastname: Lorenzini
authors.forename: Marco
authors.initials: M
authors.lastname: Pane
mesh_terms: D005260:Female; D005744:Gastric Acid / Q000378:metabolism; D005750:Gastric Juice / Q000187:drug effects / Q000382:microbiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007558:Italy; D007778:Lactobacillus / Q000145:classification / Q000254:growth & development*; D008297:Male; D019936:Probiotics / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D013270:Stomach / Q000187:drug effects* / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors