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Proton pump inhibitors (PPIs) may not causes small intestinal bacterial overgrowth



As previous studies suggested a relationship between small intestinal bacterial overgrowth (SIBO) and use of proton pump inhibitor (PPI) drugs, recent studies said that those link not completely right.

While previous studies showed complicating results where is European studies mostly indicated positive effect between PPIs and SIBO, but US studies mostly indicated negative effect; which is suggesting dietary factor may influence the outcomes, lack of standard test to diagnose SIBO, and various duration and dose of PPIs use, current studies used patients with chronic acid suppression therapy that would be expected to increase the potential for an abnormal glucose hydrogen breat testing (GBHT), a testing of breath sample for hydrogen (H2) and methane (CH4) to determine the positivity of SIBO.

Reported in the American Journal of Gastroenterology on February 14, 2012, there is no significant differences between once daily vs. twice daily PPI used to positive GHBT based on 4 criteria.
The criteria in this study include:
1. An increase in H2 greater than 20 parts per million (ppm) over baseline.
2. A sustained increase in H2 greater than 10 ppm over baseline.
3. CH4 greater than 15 ppm over baseline.
4. Both increase in H2 and CH4 over baseline (20 ppm and 15 ppm. respectively).

Thus, the suggestion of ‘No Link’ between PPIs and SIBO remain strong after adjusting for other potential confounding factors such as age, body mass index, diabetes, irritable bowel syndrome, and laxative/anti-diarrheal use.

The limitation of current study is the retrospective design, with its inherent issues of confounding and not including duration of PPI use.