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Long-term PPI use reduced microbial diversity, increased risk for CDI
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Proton pump inhibitors decreased species diversity in patients’ gut microbiota, increasing their risk for Clostridium difficile infection and other complications, according to new research data.
“Evidence has been mounting for years that long-term use of PPIs poses increased risk for a variety of associated complications, but we have never really understood why,” John DiBaise, MD, a gastroenterologist from the Mayo clinic and study researcher, said in a press release. “What this study does for the first time is demonstrate a plausible explanation for these associated conditions.”
John DiBaise
DiBaise and colleagues aimed to assess the effect of short- and long-term PPI use on fecal microbiota by sequencing fecal DNA from nine healthy volunteers (four men; mean age, 40.8 years; range, 18-57 years) assigned PPIs and five treatment-naive women (mean age, 40.8 years; range 20-63 years) with a first episode CDI. The volunteers were randomly assigned to 20 mg omeprazole once or twice daily for 28 days, and stool samples were collected before baseline, after 7 days, 28 days and 1 month after PPI discontinuation. Samples were sequenced using high throughput 16S hypervariable tag sequencing, and changes in the diversity of operational taxonomic units (OTUs) in the volunteer samples were compared with the CDI patient samples.
The researchers found that PPI use decreased OTUs after 1 week and 1 month, irrespective of patient dose or sex. Furthermore, the volunteer OTU levels dropped to levels similar to the CDI patients, which was partly reversible after 1 month of PPI discontinuation.
“We have shown that PPI use in humans reduces microbial diversity, a condition found in subjects with CDI,” the researchers concluded.
“We’re not saying people should stop taking their regular antacids; despite the many health risks associated with PPI use, they have an extensive track record of safety when used as directed,” DiBaise said. “What we are saying is that the medical and research communities should consider these medications in the context of the patient’s microbiome. This is an area that needs further study.”
Disclosure: The researchers report no relevant financial disclosures.
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