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 24 February 2018

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News

Risk of small intestinal bacterial overgrowth with use of PPIs in children

The most recent issue of the European Journal of Gastroenterology & Hepatology examines the risk of small intestinal bacterial overgrowth with chronic use of proton pump inhibitors in children.

News image

Some theorize that prolonged use of proton pump inhibitors (PPIs) may increase the risk of small intestinal bacterial overgrowth. 

Chronic acid suppression and resultant hypochlorhydria may lead to an altered intraluminal environment, which, in turn, may promote the growth of bacteria in the small intestine. 

A handful of studies measured the risk of small intestinal bacterial overgrowth in adults taking PPIs and obtained mixed results.

However, this risk has not been exclusively measured in children.

Small intestinal bacterial overgrowth was detected in 9% of the 56 participants taking PPI
European Journal of Gastroenterology & Hepatology
Dr Kristen Cares and colleagues measured the risk of small intestinal bacterial overgrowth in children taking PPI versus those not taking PPI.

The team performed a prospective cohort study. 

Evaluation of small intestinal bacterial overgrowth was performed using the glucose hydrogen breath test. 

Patients younger than 18 years of age taking a PPI longer than 6 months were compared with healthy control participants. 

After ingestion of glucose substrate, the team obtained breath samples every 15 minutes for 2 hours. 

An increase in breath hydrogen or methane above 12 ppm was considered diagnostic of small intestinal bacterial overgrowth.

Overall, the team tested 83 participants, of whom 56 were taking PPIs. 

Small intestinal bacterial overgrowth was detected in 9% of the 56 participants taking PPI versus 4% of the 27 participants in the control group, with a relative risk of 2.4.

Dr Cares' team concludes, "To our knowledge, this is the first study in the English literature measuring the risk of small intestinal bacterial overgrowth in children taking PPIs."

"Our results indicate a potential risk of small intestinal bacterial overgrowth in chronic PPI users."

"However, this is not statistically significant."

"This is an important finding as PPIs are readily prescribed for children, and are often taken longer than 6 months’ duration."

Eur J Gastroenterol Hepatol 2017: 29(4):396-399
06 March 2017

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