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Common medications linked to changes in gut microbiome
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A group of commonly used drug categories have a significant impact on the makeup of the gut microbiome, which could increase the risk for infection, obesity and other conditions, according to study results presented at UEG Week.
Arnau Vich Vila, of the department of gastroenterology and hepatology at University Medical Center Groningen in the Netherlands, and colleagues found that 18 common drug categories were associated with changes in the composition or function of the gut microbiome. Their research explored changes in the general population, as well as in patients with disorders like inflammatory bowel disease and irritable bowel syndrome.
“We already know that the efficiency and the toxicity of certain drugs are influenced by the bacterial composition of the gastrointestinal tract and that the gut microbiota has been related to multiple health conditions,” Vich Vila said in a press release. “Therefore, it is crucial to understand which are the consequences of medication use in the gut microbiome.”
Researchers performed metagenomic sequencing in 1,883 fresh frozen fecal samples taken from three independent cohorts. The first was a population-based cohort. The second comprised patients with IBD, and the third included patients with IBD intermixed with healthy controls.
Investigators compared the taxonomic and metabolic functions of individuals who did or did not use drugs. Their analysis looked at the impact of a single use of medication and the impact of combined medication use.
Of the 41 drug categories they included, Vich Vila and colleagues found that 18 were associated with significant changes in the gut microbiome. The categories with the biggest impacts were proton pump inhibitors, metformin, antibiotics and laxatives.
In the microbiomes of individuals who used PPIs, researchers found an increased abundance of upper GI tract bacteria, as well as increased fatty acid production. Among individuals who used metformin, they found higher levels of Escherichia coli.
Investigators also observed higher abundance of Eubacterium ramulus in patients with IBS who took SSRIs and found that use of oral steroids was associated with higher levels of methanogenic bacteria.
In their analysis, Vich Vila and colleagues also identified eight medications groups that appeared to increased antibiotics resistance mechanisms in the microbiome.
“Our work highlights the importance of considering the role of the gut microbiota when designing treatments and also points to new hypotheses that could explain certain side-effects associated with medication use,” Vich Vila said in the release. – by Alex Young
Reference:
Vich Vila A, et al. Abstract OP334. Presented at: UEG Week. October 19-23, 2019; Barcelona.
Disclosure s: The authors report no relevant financial disclosures.
Perspective
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Taha Qazi, MD
This was a well-done study. I think the authors were attempting to assess changes to the microbiome in patients prescribed medications and non-users. The authors also attempted control for aspects such as polypharmacy. In effect, the researchers reported what has previously been hinted at, that the microbiome is dynamic and diverse organ system that is affected not only by diet, country of origin, inflammation, but also prescribed drugs, to a certain degree.
This research suggests that the medication we provide our patients may have effect, including effects on metabolism and physiology that is beyond their intended pharmaceutical target. The authors suggested that common medications, like oral contraceptives, metformin, PPIs and laxatives increase antibiotic resistance. Obviously, we need to look at these data longitudinally to determine how these changes effect patients.
As a gastroenterologist, we most often tend to prescribe PPIs and laxatives that have tangible effects on the gut microbiome as suggested by this study. These drugs have been linked to antibiotic resistance patterns by the authors. However, in the absence of longitudinal data, I don’t think it changes my practice in providing these agents. It does provide a note of caution, however, for prescribers and patients.
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