Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Digestion. 2018;97(2):195-204. doi: 10.1159/000481813. Epub 2018 Jan 6.
Gut dysbiosis associated with the use of proton-pump inhibitors (PPIs) has been found to lead to the occurrence of infectious and inflammatory adverse events. A longitudinal observational cohort study has demonstrated the heightened risk of death associated with PPI use.
We evaluated meta-analyses to determine the association between PPI use and infectious and inflammatory diseases. Meta-analyses showed that PPI use is a potential risk for the development of enteric infections caused by Clostridium difficile, as well as small intestinal bacterial overgrowth, spontaneous bacterial peritonitis, community-acquired pneumonia, hepatic encephalopathy, and adverse outcomes in inflammatory bowel disease. We also examined changes in the composition and function of the gut microbiota with the use of PPIs. PPI use significantly increased the presence of Streptococcaceae and Enterococcaceae, which are risk factors for C. difficile infection, and decreased that of Faecalibacterium, a commensal anti-inflammatory microorganism. Key Message: High-throughput, microbial 16S rRNA gene sequencing has allowed us to investigate the association between the gut microbiome and PPI use. Future prospective comparison studies are necessary to confirm this association, and to develop new strategies to prevent complications of PPI use.
质子泵抑制剂 (PPI) 的使用与肠道菌群失调有关，而肠道菌群失调会导致感染和炎症等不良事件的发生。一项纵向观察性队列研究表明，PPI 的使用与死亡风险增加有关。
我们评估了荟萃分析，以确定 PPI 使用与感染和炎症性疾病之间的关系。荟萃分析表明，PPI 使用是导致艰难梭菌引起的肠道感染、小肠细菌过度生长、自发性细菌性腹膜炎、社区获得性肺炎、肝性脑病和炎症性肠病不良结局的潜在风险因素。我们还检查了使用 PPI 对肠道微生物群落的组成和功能的影响。PPI 使用显著增加了艰难梭菌感染的风险因素——链球菌科和肠球菌科的存在，同时减少了共生抗炎微生物——粪杆菌的存在。
高通量、微生物 16S rRNA 基因测序使我们能够研究肠道微生物组与 PPI 使用之间的关系。未来需要进行前瞻性对比研究来证实这种关联，并制定预防 PPI 使用并发症的新策略。
