Proton pump inhibitor use associated with changes in gut microbiota composition.
Reveles KR, Ryan CN, Chan L, Cosimi RA, Haynes WL
Gut. 2018 Jul;67(7):1369-1370. doi: 10.1136/gutjnl-2017-315306. Epub 2017 Oct 9.
We read with great interest the recent publications in Gut by Imhann et al and Jackson et al, which assessed the impact of proton pump inhibitor (PPI) use on gut microbiota diversity and composition in humans. PPIs are one of the most commonly used drug classes worldwide. Once initiated, they are often used chronically without clear therapeutic intent. PPIs alter GI pH and delay gastric emptying rate, which could directly affect gut microbiota and survival of enteric pathogens. Using three independent cohorts (211 PPI users and 1604 non-users), Imhann et al reported a significant decrease in alpha diversity and changes in 20% of bacterial taxa in PPI users compared with non-users. Among 1827 healthy twins, Jackson et al also found a significant decrease in alpha diversity and alteration of bacterial composition in PPI users. Notably, both studies found a higher abundance of oral commensals, including Streptococcaceae, among PPI users. These studies controlled for some potential confounders in their analyses; however, intersubject variability could have influenced their results.