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 These pills work by stopping cells in the stomach lining from
producing too much acid, which can prevent ulcers from forming and
reduce reflux symptoms such as heartburn. The trouble is the drugs
are also linked to an increased risk of bacterial infections such as
pneumonia, which damages the lungs, and Clostridium difficile, which
causes severe diarrhea.
Looking for clues to how PPIs might lead to infections, researchers
compared stool samples from more than 1,800 British twins. When only
one twin used PPIs, their fecal analysis turned up much more
Streptococcaceae, a family of bacteria that includes Streptococcus
and Lactococcus strains, and that typically inhabits the mouth and
skin. Their increased numbers potentially make certain infections
more likely, the researchers conclude in the journal Gut.
“By reducing the natural barrier of stomach acid, PPIs appear to let
more bacteria from the skin, nose and mouth into the gut – and this
can be detected in the stool samples,” senior study author Dr.
Claire Steves of Kings College London said by email.
Because millions of people worldwide take PPIs, which are available
without a prescription in Europe and the U.S., it’s crucial to
understand how infections might unfold in the gut and be cautious to
avoid over-use of the medicines, Steves added.
The drugs are generally safe, and very effective for treating ulcers
and inflammation caused by excessive stomach acid, and the benefit
of PPIs for these patients would outweigh the risk of harms posed by
infections, Steves said.
But many patients who take PPIs for minor, temporary digestive
discomfort don’t need them, and many people also remain on the pills
much longer than necessary, Steves said.
“This study may play a part in reducing this unnecessary use, by
providing the mechanism of the slight increase in infections,”
Steves said.
That’s because to confirm the shift in gut bacteria found in twins
taking PPIs, Steves and colleagues also re-analyzed data from a
previously published study examining what happens to the guts of
healthy people who take the pills. In these individuals, the mix of
bacteria changed to resemble that of the twins on PPIs.
The changes in the gut seen in these studies also mirror what has
been observed in previous research on mice with high levels of
streptococcus in their stomachs, which predisposed them to
Clostridium difficile infections, the researchers note.
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More human studies are still needed to investigate this possibility
in people, even though the findings suggest a potential mechanism
for PPIs to directly cause infections, the researchers conclude.
“Despite the correlations with certain disorders in individuals
using PPIs found in epidemiological studies, the causative role of
PPIs remains unclear,” said Dr. John DiBaise, a researcher at the
Mayo Clinic in Scottsdale, Arizona who wasn’t involved in the study.
“I don’t think the current study provides any clear cut evidence of
causation,” DiBaise added by email.
Still, the findings add to a growing body of evidence suggesting
that patients should be cautious with PPIs, particularly when they
get the drugs without a prescription, said Dr. Wojciech Marlicz, a
researcher at Pomeranian Medical University in Poland who wasn’t
involved in the study.
Patients who do use PPIs might also consider taking probiotics at
the same time, which have the potential to counter changes in the
gut triggered by the heartburn pills, Marlicz said by email.
SOURCE: http://bit.ly/1JwVDWZ Gut, online December 30, 2015.
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