RT Journal Article
SR Electronic
T1 Proton pump inhibitors alter the composition of the gut microbiota
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 749
OP 756
DO 10.1136/gutjnl-2015-310861
VO 65
IS 5
A1 Matthew A Jackson
A1 Julia K Goodrich
A1 Maria-Emanuela Maxan
A1 Daniel E Freedberg
A1 Julian A Abrams
A1 Angela C Poole
A1 Jessica L Sutter
A1 Daphne Welter
A1 Ruth E Ley
A1 Jordana T Bell
A1 Tim D Spector
A1 Claire J Steves
YR 2016
UL http://gut.bmj.com/content/65/5/749.abstract
AB Objective Proton pump inhibitors (PPIs) are drugs used to suppress gastric acid production and treat GI disorders such as peptic ulcers and gastro-oesophageal reflux. They have been considered low risk, have been widely adopted, and are often over-prescribed. Recent studies have identified an increased risk of enteric and other infections with their use. Small studies have identified possible associations between PPI use and GI microbiota, but this has yet to be carried out on a large population-based cohort.Design We investigated the association between PPI usage and the gut microbiome using 16S ribosomal RNA amplification from faecal samples of 1827 healthy twins, replicating results within unpublished data from an interventional study.Results We identified a significantly lower abundance in gut commensals and lower microbial diversity in PPI users, with an associated significant increase in the abundance of oral and upper GI tract commensals. In particular, significant increases were observed in Streptococcaceae. These associations were replicated in an independent interventional study and in a paired analysis between 70 monozygotic twin pairs who were discordant for PPI use. We propose that the observed changes result from the removal of the low pH barrier between upper GI tract bacteria and the lower gut.Conclusions Our findings describe a significant impact of PPIs on the gut microbiome and should caution over-use of PPIs, and warrant further investigation into the mechanisms and their clinical consequences.