慢性质子泵抑制剂治疗患者小肠细菌过度生长及甲烷生成的评估：利福昔明在基层医疗管理中的患病率及作用

Assessment of small intestinal bacterial overgrowth and methane production in patients on chronic proton-pump inhibitor treatment: prevalence and role of rifaximin in its management in primary care.

作者信息

DE Bastiani Rudi, Lopetuso Loris R, DE Bastiani Marco, Bacchin Paolo, Benedetto Edoardo, Boscariolo Laura, Caneve Rosanna, Chesani Fabio, Chiumeo Francesco, Civic Zinaida, Dainese Antonio, DE Polo Manuela, Disclafani Giuseppe, Grattagliano Ignazio, Mana Ornella, Mancuso Maurizio, Mastronuzzi Tecla, Pati Antonino, Pirrotta Enzo, Salandini Maurizio, Sanna Guido, Scoglio Riccardo, Severino Pietro, Tosetti Cesare, Turnava Leyla, Zamparella Maria, Elisei Walter, Gasbarrini Antonio, Tursi Antonio

机构信息

GIGA-CP Italian Association for Primary Care Gastroenterology, Feltre, Belluno, Italy.

Department of Medical and Surgical Sciences, Sacred Heart Catholic University, Rome, Italy.

出版信息

Minerva Gastroenterol (Torino). 2023 Dec;69(4):523-528. doi: 10.23736/S2724-5985.21.03118-1. Epub 2023 Mar 21.

DOI:10.23736/S2724-5985.21.03118-1

PMID:36943203

Abstract

BACKGROUND

Although proton pump inhibitor (PPI) drugs have considered able to induce small intestinal bacterial overgrowth (SIBO), no data are so far available from primary care (PC). We assessed the prevalence of SIBO and methane (CH4) production consequent to chronic PPI therapy using Lactulose Breath Test (LBT). Secondary aim was to explore the possible role of rifaximin in treating PPI-induced SIBO patients.

METHODS

One hundred twenty-five gastroesophageal reflux disease patients, constantly treated with PPI for at least 6 months and undergoing to LBT, were retrospectively assessed. An age-matched control population (control) of 100 patients, which had not used PPI in the last 6 months, was also enrolled. In the PPI group, SIBO positive patients and CH4 producers were treated with rifaximin 1200 mg/daily for 14 days and re-checked with LBT one month after the end of treatment. The area under the curve (AUC) before and after treatment was also calculated for both SIBO positive patients and CH4 producers.

RESULTS

In the PPI group, SIBO prevalence was significantly higher vs. controls (38/125 [30.4%] vs. 27/100 [27%], P<0.05). 77/125 (61.6%) PPI patients were found to be CH4 producers vs. 21/100 (21%) controls (P<0.05). Among SIBO patients in the PPI group, 34 (89.4%) were also CH4 producers vs. 17/27 (63%) controls (P<0.05). After treatment, LBT resulted negative in 15/22 SIBO patients (68.1%) (P<0.05) and in 18/34 CH4 producers (52.9%) (P<0.05). At the AUC analysis, an overall reduction of 54.2% for H2 in SIBO patients and of 47.7% for CH4 was assessed after rifaximin treatment (P<0.05).

CONCLUSIONS

Our data showed that chronic use of PPI could be able to increase the prevalence of SIBO and to shift the intestinal microbial composition towards a CH4-producing flora. rifaximin could represent a useful therapeutical option for PPI-induced SIBO and for modulating CH4-producing flora.

摘要

背景

尽管质子泵抑制剂（PPI）药物被认为能够诱发小肠细菌过度生长（SIBO），但目前尚无来自基层医疗（PC）的数据。我们使用乳果糖呼气试验（LBT）评估了慢性PPI治疗导致的SIBO和甲烷（CH₄）产生的患病率。次要目的是探讨利福昔明在治疗PPI诱导的SIBO患者中的可能作用。

方法

回顾性评估了125例胃食管反流病患者，这些患者持续接受PPI治疗至少6个月并接受LBT检查。还纳入了100例年龄匹配的对照人群（对照组），他们在过去6个月内未使用PPI。在PPI组中，SIBO阳性患者和CH₄产生者接受利福昔明1200mg/天治疗14天，并在治疗结束后1个月用LBT重新检查。还计算了SIBO阳性患者和CH₄产生者治疗前后的曲线下面积（AUC）。

结果

在PPI组中，SIBO患病率显著高于对照组（38/125 [30.4%] 对27/100 [27%]，P<0.05）。发现77/125（61.6%）的PPI患者是CH₄产生者，而对照组为21/100（21%）（P<0.05）。在PPI组的SIBO患者中，34例（89.4%）也是CH₄产生者，而对照组为17/27（63%）（P<0.05）。治疗后，15/22例SIBO患者（68.1%）的LBT结果为阴性（P<0.05），18/34例CH₄产生者（52.9%）的LBT结果为阴性（P<0.05）。在AUC分析中，利福昔明治疗后，SIBO患者的H₂总体降低了54.2%，CH₄降低了47.7%（P<0.05）。