Cares Kristen, Al-Ansari Namir, Macha Suhasini, Zoubi Najeeb, Zaghloul Hazim, Thomas Ron, Lalinsky Patricia, El-Baba Mohammad
aDepartment of Pediatric Gastroenterology bChildren's Research Center, Children's Hospital of Michigan, Detroit, Michigan.
Eur J Gastroenterol Hepatol. 2017 Apr;29(4):396-399. doi: 10.1097/MEG.0000000000000815.
Some theorize that prolonged use of proton pump inhibitors (PPIs) may increase the risk of small intestinal bacterial overgrowth (SIBO). Chronic acid suppression and resultant hypochlorhydria may lead to an altered intraluminal environment, which, in turn, may promote the growth of bacteria in the small intestine. A handful of studies measured the risk of SIBO in adults taking PPIs and obtained mixed results; however, this risk has not been exclusively measured in children.
This study aimed to measure the risk of SIBO in children taking PPI versus those not taking PPI.
This was a prospective cohort study. Evaluation of SIBO was performed using the glucose hydrogen breath test. Patients younger than 18 years of age taking a PPI longer than 6 months were compared with healthy control participants. After ingestion of glucose substrate, breath samples were obtained every 15 min for 2 h. An increase in breath hydrogen or methane above 12 ppm was considered diagnostic of SIBO.
Overall, 83 participants were tested, of whom 56 were taking PPIs. SIBO was detected in five (8.9%) of the 56 participants taking PPI versus one (3.7%) of the 27 participants in the control group (P=0.359), with a relative risk of 2.4 (95% confidence interval: 0.29-19.6).
To our knowledge, this is the first study in the English literature measuring the risk of SIBO in children taking PPIs. Our results indicate a potential risk of SIBO in chronic PPI users; however, this is not statistically significant. This is an important finding as PPIs are readily prescribed for children and are often taken longer than 6 months' duration.
一些人推测，长期使用质子泵抑制剂（PPI）可能会增加小肠细菌过度生长（SIBO）的风险。长期的胃酸抑制以及由此导致的胃酸过少可能会导致管腔内环境改变，进而可能促进小肠内细菌的生长。一些研究测量了服用PPI的成年人患SIBO的风险，结果不一；然而，尚未专门针对儿童测量这种风险。
本研究旨在测量服用PPI的儿童与未服用PPI的儿童患SIBO的风险。
这是一项前瞻性队列研究。使用葡萄糖氢呼气试验评估SIBO。将年龄小于18岁且服用PPI超过6个月的患者与健康对照参与者进行比较。摄入葡萄糖底物后，每隔15分钟采集一次呼气样本，持续2小时。呼气中氢气或甲烷增加超过12 ppm被认为是SIBO的诊断标准。
总体而言，共测试了83名参与者，其中56名正在服用PPI。服用PPI的56名参与者中有5名（8.9%）检测出SIBO，而对照组的27名参与者中有1名（3.7%）检测出SIBO（P = 0.359），相对风险为2.4（95%置信区间：0.29 - 19.6）。
据我们所知，这是英文文献中第一项测量服用PPI的儿童患SIBO风险的研究。我们的结果表明长期使用PPI的儿童存在患SIBO的潜在风险；然而，这在统计学上并不显著。这是一个重要的发现，因为PPI很容易给儿童开处方，而且服用时间通常超过6个月。
