Thorens J, Froehlich F, Schwizer W, Saraga E, Bille J, Gyr K, Duroux P, Nicolet M, Pignatelli B, Blum A L, Gonvers J J, Fried M
Department of Gastroenterology, University Hospital, Lausanne, Switzerland.
Gut. 1996 Jul;39(1):54-9. doi: 10.1136/gut.39.1.54.
Gastric and duodenal bacterial overgrowth frequently occurs in conditions where diminished acid secretion is present. Omeprazole inhibits acid secretion more effectively than cimetidine and might therefore more frequently cause bacterial overgrowth.
This controlled prospective study compared the incidence of gastric and duodenal bacterial overgrowth in patients treated with omeprazole or cimetidine.
47 outpatients with peptic disease were randomly assigned to a four week treatment regimen with omeprazole 20 mg or cimetidine 800 mg daily. Gastric and duodenal juice were obtained during upper gastrointestinal endoscopy and plated for anaerobic and aerobic organisms.
Bacterial overgrowth (> or = 10(5) cfu/ml) was present in 53% of the patients receiving omeprazole and in 17% receiving cimetidine (p < 0.05). The mean (SEM) number of gastric and duodenal bacterial counts was 6.0 (0.2) and 5.0 (0.2) respectively in the omeprazole group and 4.0 (0.2) and 4.0 (0.1) in the cimetidine group (p < 0.001 and < 0.01; respectively). Faecal type bacteria were found in 30% of the patients with bacterial overgrowth. Basal gastric pH was higher in patients treated with omeprazole compared with cimetidine (4.2 (0.5) versus 2.0 (0.2); p < 0.001) and in patients with bacterial overgrowth compared with those without bacterial overgrowth (5.1 (0.6) versus 2.0 (0.1); p < 0.0001). The nitrate, nitrite, and nitrosamine values in gastric juice did not increase after treatment with either cimetidine or omeprazole. Serum concentrations of vitamin B12, beta carotene, and albumin were similar before and after treatment with both drugs.
These results show that the incidence of gastric and duodenal bacterial overgrowth is considerably higher in patients treated with omeprazole compared with cimetidine. This can be explained by more pronounced inhibition of gastric acid secretion. No patient developed signs of malabsorption or an increase of N-nitroso compounds. The clinical significance of these findings needs to be assessed in studies with long-term treatment with omeprazole, in particular in patients belonging to high risk groups such as HIV infected and intensive care units patients.
胃酸和十二指肠细菌过度生长常发生于胃酸分泌减少的情况。奥美拉唑比西咪替丁更有效地抑制胃酸分泌，因此可能更频繁地导致细菌过度生长。
这项对照前瞻性研究比较了接受奥美拉唑或西咪替丁治疗的患者中胃和十二指肠细菌过度生长的发生率。
47例患有消化性疾病的门诊患者被随机分配到每日服用20mg奥美拉唑或800mg西咪替丁的四周治疗方案中。在上消化道内镜检查期间获取胃和十二指肠液，并接种培养需氧菌和厌氧菌。
接受奥美拉唑治疗的患者中有53%存在细菌过度生长（≥10⁵cfu/ml），接受西咪替丁治疗的患者中有17%存在细菌过度生长（p<0.05）。奥美拉唑组胃和十二指肠细菌计数的平均值（标准误）分别为6.0（0.2）和5.0（0.2），西咪替丁组分别为4.0（0.2）和4.0（0.1）（分别为p<0.001和<0.01）。在有细菌过度生长的患者中，30%发现了粪便型细菌。与西咪替丁治疗的患者相比，奥美拉唑治疗的患者基础胃pH值更高（4.2（0.5）对2.0（0.2）；p<0.001），与无细菌过度生长的患者相比，有细菌过度生长的患者基础胃pH值更高（5.1（0.6）对2.0（0.1）；p<0.0001）。用西咪替丁或奥美拉唑治疗后，胃液中的硝酸盐、亚硝酸盐和亚硝胺值均未增加。两种药物治疗前后血清维生素B12、β-胡萝卜素和白蛋白浓度相似。
这些结果表明，与西咪替丁相比，接受奥美拉唑治疗的患者中胃和十二指肠细菌过度生长的发生率显著更高。这可以通过对胃酸分泌更明显的抑制来解释。没有患者出现吸收不良的迹象或N-亚硝基化合物增加。这些发现的临床意义需要在奥美拉唑长期治疗的研究中进行评估，特别是在属于高危人群的患者中，如艾滋病毒感染者和重症监护病房患者。
