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No link found between proton pump inhibitors and small intestinal bacteria
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No significant association exists between proton pump inhibitor use and small intestinal bacterial overgrowth, according to study results.
Researchers performed a retrospective chart review on 1,191 patients who received glucose hydrogen breath testing between 2004 and 2010. Patients were split into two groups according to whether they used proton pump inhibitors, with 48% of the sample (n=566) having used the therapy. Breath tests measuring hydrogen (H2) and methane (CH4) were administered before participants orally ingested 50 g glucose, and then again every 20 minutes for 2 hours. Test results indicating small intestinal bacterial overgrowth were considered positive under the following criteria: H2 .20 ppm over baseline, a sustained rise of H2 .10 ppm over baseline, CH4 .15 ppm over baseline, and either a rise of H2 .20 ppm over baseline or CH4 .15 ppm.
Investigators did not find a statistically significant link between proton pump inhibitor use and positive results from the glucose hydrogen breath tests. Positive test results were linked to older age (OR=1.03; 95% CI, 1.01-1.04) and the use of antidiarrheal medications (OR=1.96; 95% CI, 1.14-3.38) under the H2 .20 ppm criterion. Using the sustained H2 .10 ppm criterion, age (OR=1.01; 95% CI, 1.01-1.02) and diarrhea indications (OR=1.52; 95% CI, 1.11-2.06) were linked to positive results. Advanced age also was linked to positive test results under the H2 .20 ppm over baseline or CH4 .15 ppm criterion (OR=1.01; 95% CI, 1.01-1.02), and no statistically significant associations were established under the CH4 .15 ppm criterion.
“We did not find any differences in the proportion of patients with an abnormal breath test using a variety of published criteria between patients undergoing a [glucose hydrogen breath test] while on or off [proton pump inhibitor] therapy,” the researchers wrote, adding that sample sizes, patient demographics, geography and other factors could explain variant results obtained from other studies. “Further prospective studies are needed to confirm these findings.”
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