Proton pump inhibitor therapy use does not predispose to small intestinal bacterial overgrowth.

Am J Gastroenterol. 2012 May;107(5):730-5

Authors: Ratuapli SK, Ellington TG, O'Neill MT, Umar SB, Harris LA, Foxx-Orenstein AE, Burdick GE, Dibaise JK, Lacy BE, Crowell MD

Abstract

OBJECTIVES: Small intestinal bacterial overgrowth (SIBO) occurs due to alteration of the microbiota within the upper gastrointestinal tract. Proton pump inhibitor (PPI) therapy has been suggested as a risk factor for SIBO; however, the published reports have yielded conflicting results on the association between PPI therapy and risk of developing SIBO. The aim of this study was to compare the prevalence of SIBO as measured by glucose hydrogen breath testing (GHBT) in patients on PPI therapy compared with those not on PPI therapy.

METHODS: A retrospective chart review was completed for all patients who underwent GHBT testing from 2004 to 2010. Breath samples for hydrogen (HâÂÂ) and methane (CHâÂÂ) were collected before and every 20âÂÂmin for 120âÂÂmin following ingestion of a 50-g oral glucose load. We used the following criteria to define a positive GHBT (a) increase in Hâ > 20 parts per million (p.p.m.) over baseline, (b) sustained rise Hâ > 10âÂÂp.p.m. over baseline, (c) CHâ > 15âÂÂp.p.m. over baseline, and (d) either rise Hâ > 20âÂÂp.p.m. over baseline or CHâ > 15âÂÂp.p.m.

RESULTS: A total of 1,191 patients (70% female) were included, of whom 566 (48%) were on PPI therapy. GHBT positivity did not differ significantly between PPI users and nonusers by any of the diagnostic criteria used and PPI use was not significantly associated with GHBT positivity using any of these criteria. GHBT positivity was associated with older age (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01-1.04) and antidiarrheal use (OR 1.99, 95% CI 1.15-3.44) using Hâ > 20, older age (OR 1.01, 95% CI 1.00-1.02) and diarrhea (OR 1.53, 95% CI 1.13-2.09) using Hâ > 10, and older age (OR 1.01, 95% CI 1.00-1.02) using either Hâ > 20 or CHâ > 15. PPI use was not significantly associated with GHBT positivity using any of these criteria.

CONCLUSIONS: In this large, adequately powered equivalence study, PPI use was not found to be significantly associated with the presence of SIBO as determined by the GHBT.

PMID: 22334250 [PubMed - indexed for MEDLINE]

Secondary Prophylaxis of Hepatic Encephalopathy in Cirrhosis: An Open-Label, Randomized Controlled Trial of Lactulose, Probiotics, and No Therapy.

Am J Gastroenterol. 2012 Jun 19;

Authors: Agrawal A, Sharma BC, Sharma P, Sarin SK

Abstract

OBJECTIVES:Lactulose is effective in secondary prophylaxis of hepatic encephalopathy (HE). Probiotics improves minimal hepatic encephalopathy (MHE), which predisposes to HE. No study has been conducted on the secondary prophylaxis of HE using probiotics. Our objective was to study the effects of lactulose and probiotics for secondary prophylaxis of HE.METHODS:Consecutive cirrhotic patients who had recovered from HE were randomized to receive lactulose (Gp-L, 30âÂÂml three times per day), three capsules of probiotics (Gp-P) per day containing 112.5 billion viable lyophilized bacteria per capsule, or no therapy (Gp-N). All patients were assessed by psychometry (number connection test (NCT-A, B), figure connection test if illiterate (FCT-A, B), digit symbol test (DST), and block design test (BDT)), critical flicker frequency (CFF) test, and arterial ammonia at inclusion. The patients were followed up monthly. The primary end point was development of overt HE according to West Haven criteria or a follow-up of 12 months.RESULTS:Of 360 patients who recovered, 235 (65.2%) met the inclusion criteria (Gp-L, n=80; Gp-P, n=77; and Gp-N, n=78). In all, 38 patients (16.1%) were lost to follow-up and 77 patients developed HE (Gp-L, n=18; Gp-P, n=22; and Gp-N, n=37). There was a significant difference between Gp-L and Gp-N (P=0.001) and between Gp-P and Gp-N (P=0.02) but no difference between the Gp-L and Gp-P groups (P=0.349). The rate of readmission for causes other than HE (Gp-L, Gp-P, and Gp-N, 19:21:28; P=0.134) and deaths (Gp-L:Gp-P:Gp-N=13:11:16; P=0.56) in all three groups were similar. There was a high prevalence of abnormal psychometry test results (NCT-A, 71.5%; NCT-B, 69.2%; DST, 76.9%; and BDT, 85.2%), and FCT-A and -B were abnormal in 35 of 48 patients (72.7%). CFF was <38âÂÂHz in 118 patients (50.2%). Upon multivariate analysis, recurrence of overt HE was significantly associated with two or more abnormal psychometric tests and arterial ammonia after the recovery of an episode of HE.CONCLUSIONS:Lactulose and probiotics are effective for secondary prophylaxis of HE in patients with cirrhosis.Am J Gastroenterol advance online publication, 19 June 2012; doi:10.1038/ajg.2012.113.

PMID: 22710579 [PubMed - as supplied by publisher]