Proton Pump Inhibitor Use and the Risk of Small Intestinal Bacterial Overgrowth: A Meta-analysis

Lo, Wai–Kit; Chan, Walter W.

doi:10.1016/j.cgh.2012.12.011

Cited by 353Gastrointestinal motility and disordersGut microbiota and healthGastroesophageal reflux and treatments

Proton Pump Inhibitor Use and the Risk of Small Intestinal Bacterial Overgrowth: A Meta-analysis

Lo, Wai–Kit, Chan, Walter W.·2013·Clinical Gastroenterology and Hepatology

DOI 10.1016/j.cgh.2012.12.011

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Abstract

Background & aims Use of proton pump inhibitors (PPIs) could predispose individuals to small intestinal bacterial overgrowth (SIBO) by altering the intraluminal environment and bacterial flora. There is controversy regarding the risk of SIBO among PPI users because of conflicting results from prior studies. A systematic review and meta-analysis were performed to evaluate the association between PPI use and SIBO, using objective clinical outcome measures.Methods Clinical studies comparing SIBO risk among adult users of PPIs vs nonusers were identified in MEDLINE/PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and the National Institutes of Health Clinical Trials databases through July 2012. Two reviewers independently extracted data on study characteristics and outcomes. The primary metameter was the odds ratio (OR) of SIBO among PPI users vs nonusers. Subgroup analyses were performed to examine the influence of study characteristics, such as SIBO diagnostic modality, on study outcome.Results Eleven studies (n = 3134) met inclusion criteria. The pooled OR of SIBO in PPI users vs nonusers was 2.282 (95% confidence interval [CI], 1.238-4.205). No significant single large study or temporal effect was seen. Subgroup analysis revealed an association between SIBO and PPI use in studies that used duodenal or jejunal aspirate cultures to diagnose SIBO (OR, 7.587; 95% CI, 1.805-31.894), but no relationship was found between SIBO and PPI use in studies that used the glucose hydrogen breath test (OR, 1.93; 95% CI, 0.69-5.42). Funnel plot analysis identified 4 outlying studies, indicating the possible presence of publication bias.Conclusions PPI use statistically was associated with SIBO risk, but only when the diagnosis was made by a highly accurate test (duodenal or jejunal aspirate culture). Differences in study results could arise from the use of different tests to diagnose SIBO.

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Chronic treatment with PPIs strongly impacts small intestine microbiota and, in particular, causes small intestinal bacterial overgrowth (SIBO), likely due to the loss of the gastric acid defensive barrier.
“Chronic treatment with PPIs strongly impacts small intestine microbiota and, in particular, causes small intestinal bacterial overgrowth (SIBO), likely due to the loss of the gastric acid defensive barrier[81-83].”
From Proton pump inhibitors and dysbiosis: current knowledge and aspects to be clarified (2019) · cites this paper as [83]

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Authors: Lo, W., & Chan, W. W.
Affiliations: Brigham and Women's Hospital (US)
Corresponding author: Chan, Walter W.
ORCID: Lo, Wai–Kit
Chan, Walter W.
Venue: Clinical Gastroenterology and Hepatology
Publisher: Elsevier BV
Published: 2013-05
Volume: 11
Issue: 5
Pages: 483-490
ISSN: 1542-3565 (ISSN-L)
DOI: 10.1016/j.cgh.2012.12.011
OpenAlex: W2097092684
Cited by: 353
References: 42
Citations by year: 2026: 13 · 2025: 25 · 2024: 32 · 2023: 32 · 2022: 25 · 2021: 26 · 2020: 39 · 2019: 25 · 2018: 27 · 2017: 39 · 2016: 21 · 2015: 18 · 2014: 23 · 2013: 5 · 2012: 1
FWCI: 2.19
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Gastroenterology and Hepatology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
Keywords: proton pump inhibitors, small intestinal bacterial overgrowth, glucose hydrogen breath test, SIBO diagnosis, publication bias
MeSH terms: Bacterial Infections, Humans, Intestine, Small, Superinfection, Risk Assessment, Proton Pump Inhibitors

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Proton Pump Inhibitor Use and the Risk of Small Intestinal Bacterial Overgrowth: A Meta-analysis

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