PPI Use and Changes in Bacterial Flora Associated with C. difficile Infection.

[Argirios Argiriou]

November 5, 2015

David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) reviewing Freedberg DE et al. Gastroenterology 2015 Oct.

Although overall bacterial diversity remained unaltered after 4 weeks of high-dose proton-pump inhibitor treatment, certain taxa that may affect CDI risk showed changes in relative abundance.

Proton-pump inhibitor (PPI) use is believed to increase the risk for Clostridium difficile infection (CDI), presumably by altering the bacteria normally found in the gut. To further investigate this presumption, researchers conducted a prospective, open-label trial involving 12 healthy volunteers.

Stool samples were obtained at baseline and 4 weeks, after which all participants received 40 mg of omeprazole twice daily for 4 weeks, and another stool sample was obtained. Half of the participants then stopped the PPI, and half continued it for an additional 4 weeks. A final stool sample was collected from all at 12 weeks. Samples were analyzed using 16S ribosomal RNA gene sequencing.

Although PPI therapy did not affect overall bacterial diversity in stool, certain taxa that have been associated with antibiotic exposure and increased CDI risk (specifically, enterococci and streptococci) were increased in relative abundance, and Clostridiales species were decreased. PPI treatment also increased bacterial genes associated with epithelial invasion and the renin-angiotensin pathway. There were no changes in bile salts.

COMMENT

This is a very small, open-label study in volunteers whose diet was not controlled or recorded. The changes noted in particular bacterial taxa and in genes associated with epithelial invasion suggest a potential mechanism by which PPI use could affect CDI risk. Further studies are needed to replicate these results and clarify the mechanism. Large, prospective trials are necessary to determine whether these changes translate into clinically significant changes in CDI risk in particular patient groups.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) at time of publication
Leadership positions in professional societiesWorld Gastroenterology Organization (Treasurer)

CITATION(S):

Freedberg DE et al. Proton pump inhibitors alter specific taxa in the human gastrointestinal microbiome: A crossover trial. Gastroenterology 2015 Oct; 149:883. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)
PubMed abstract (Free)

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