Association between chronic use of proton pump inhibitors and small- intestinal bacterial overgrowth assessed using lactulose hydrogen breath tests.
OBJECTIVE
Several adverse events have been reported in patients who are chronic users of proton pump inhibitors (PPIs); however, the association between PPI use and small-intestinal bacterial overgrowth (SIBO) is controversial. We examined the prevalence of SIBO, as assessed by the lactulose hydrogen breath test (LHBT), based on the use of gastric acid-suppressive drugs in Japanese patients. METH- ODOLOGY: Ninety-four patients who were examined by the LHBT were assessed retrospectively. We used several criteria to define a positive LHBT result. Nine patients received probiotics containing Lactobacillus casei.


RESULTS
Fifty patients were PPI users, 14 were histamine-2 receptor antagonist (H2RA) users, and were 30 non-PPI and non-H2RA users (controls). There were no significant differences in prevalence of LHBT-positive cases among the three groups. Multiple-adjusted regression showed no significant association between PPI use and being LHBT-positive. Prevalence of postprandial fullness in PPI users was high (46%), but such symptoms were not related to LHBT results. Four (44%) of 9 cases became LHBT-negative and the maximal peak of H2 production decreased significantly after probiotic treatment.


CONCLUSIONS
PPI treatment is not associated with SIBO in Japanese patients. Mechanisms apart from SIBO could cause the high prevalence of postprandial fullness in PPI users.
Yasuhiro
Y
Fujiwara
Toshio
T
Watanabe
Motoko
M
Muraki
Hirokazu
H
Yamagami
Tetsuya
T
Tanigawa
Masatsugu
M
Shiba
Kazunari
K
Tominaga
Tetsuo
T
Arakawa
D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000187:drug effects* / Q000254:growth & development / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D001944:Breath Tests; D005260:Female; D005740:Gases; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D006859:Hydrogen / Q000378:metabolism*; D007421:Intestine, Small / Q000187:drug effects* / Q000382:microbiology; D007564:Japan / Q000453:epidemiology; D007792:Lactulose / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D019936:Probiotics / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D013997:Time Factors
D015415:Biomarkers; D005740:Gases; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D007792:Lactulose; D006859:Hydrogen