So-called proton pump inhibitors (PPI) like omeprazole (Prilosec)
and esomeprazole (Nexium) can be available by prescription or over
the counter and are among the top 10 most widely used drugs in the
world. They may cause side effects like diarrhea, nausea and
vomiting, and some studies have linked them with an increased risk
of the Clostridium difficile infection.
Clostridium difficile, or “C. diff,” attacks the intestinal lining
and causes severe diarrhea and pain.
“I think mostly general practitioners and medical doctors should be
aware of these side effects,” said lead author Floris Imhann of the
University of Groningen and University Medical Center Groningen in
“Individual risk (of C. diff) is fairly low,” but PPIs are widely
used, and often overused, Imhann told Reuters Health by phone.
The researchers analyzed the gut bacteria compositions of 1,815
adults in the Netherlands, some who were healthy and some with
gastrointestinal diseases like irritable bowel syndrome.
Participants reported their current medication use and gut
complaints in a questionnaire and provided stool samples. The
researchers isolated microbial DNA from the stool samples.
Just over 10 percent of the participants said they were using a
proton pump inhibitor, including 8 percent of the healthy general
population and 20 percent of those with inflammatory bowel disease.
PPI users tended to be older and have a higher body mass index than
Those using PPIs had less diversity of their gut microbes, the
researchers reported in the journal Gut. They also had more bacteria
usually found in the mouth and bacteria associated with infection in
their stool samples.
This may be because PPIs reduce the acidity of the stomach, so more
oral bacteria survive the journey from mouth to gut along with food.
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Using PPIs appeared to have a greater effect on the gut “microbiome”
than using antibiotics, the authors wrote.
“These PPIs, they are very good drugs, they work really well,” said
senior author Dr. Rinse K. Weersma. But many people take them over
the counter and about half the time, they’re not being taken
appropriately, he said.
According to this study, people who take the drugs have beneficial
bacteria in lower numbers and more harmful bacteria in higher
numbers, he said.
“Once they are started most people do not think about stopping
them,” Weersma told Reuters Health by phone.
In the Netherlands, PPIs are very widely used, and antibiotics are
not as common as in the U.S., so PPIs cause a greater disturbance to
the microbiome, Imhann said.
PPI use makes some infections 1.5 times as likely, he said.
“Knowledge is lacking there, the perception is still that they’re
relatively safe,” Weersma said.
SOURCE: http://bit.ly/1MlI2fI Gut online December 9, 2015.
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