Fujiwara Yasuhiro, Watanabe Toshio, Muraki Motoko, Yamagami Hirokazu, Tanigawa Tetsuya, Shiba Masatsugu, Tominaga Kazunari, Arakawa Tetsuo
Hepatogastroenterology. 2015 Mar-Apr;62(138):268-72.
BACKGROUND/AIMS: Several adverse events have been reported in patients who are chronic users of proton pump inhibitors (PPIs); however, the association between PPI use and small-intestinal bacterial overgrowth (SIBO) is controversial. We examined the prevalence of SIBO, as assessed by the lactulose hydrogen breath test (LHBT), based on the use of gastric acid-suppressive drugs in Japanese patients. METH- ODOLOGY: Ninety-four patients who were examined by the LHBT were assessed retrospectively. We used several criteria to define a positive LHBT result. Nine patients received probiotics containing Lactobacillus casei.
Fifty patients were PPI users, 14 were histamine-2 receptor antagonist (H2RA) users, and were 30 non-PPI and non-H2RA users (controls). There were no significant differences in prevalence of LHBT-positive cases among the three groups. Multiple-adjusted regression showed no significant association between PPI use and being LHBT-positive. Prevalence of postprandial fullness in PPI users was high (46%), but such symptoms were not related to LHBT results. Four (44%) of 9 cases became LHBT-negative and the maximal peak of H2 production decreased significantly after probiotic treatment.
PPI treatment is not associated with SIBO in Japanese patients. Mechanisms apart from SIBO could cause the high prevalence of postprandial fullness in PPI users.
背景/目的：已有报道称，长期使用质子泵抑制剂（PPI）的患者会出现多种不良事件；然而，PPI使用与小肠细菌过度生长（SIBO）之间的关联存在争议。我们基于日本患者使用胃酸抑制药物的情况，通过乳果糖氢呼气试验（LHBT）评估了SIBO的患病率。方法：对94例接受LHBT检查的患者进行回顾性评估。我们采用了多种标准来定义LHBT阳性结果。9例患者接受了含有干酪乳杆菌的益生菌治疗。结果：50例患者使用PPI，14例使用组胺-2受体拮抗剂（H2RA），30例既不使用PPI也不使用H2RA（对照组）。三组之间LHBT阳性病例的患病率无显著差异。多元校正回归显示，PPI使用与LHBT阳性之间无显著关联。PPI使用者餐后饱腹感的患病率较高（46%），但此类症状与LHBT结果无关。9例患者中有4例（44%）在接受益生菌治疗后LHBT结果转为阴性，氢气产生的最大峰值显著下降。结论：在日本患者中，PPI治疗与SIBO无关。除SIBO外的其他机制可能导致PPI使用者餐后饱腹感的高患病率。
