Proton pump inhibitors affect the microbiome

Proton pump inhibitors (PPI) are used to reduce gastric acid production in individuals’ guts and are prescribed to treat ulcers, gastroesophogeal reflux disease (GERD), and other conditions associated with acid production. It is one of the most commonly used drugs in the world. We know (and have written about) that PPIs are associated with increased intestinal infections, specifically Clostridium difficile, and the gut microbiome plays an important role in infections of the intestine. A recent study looked at the influence that PPIs had on the gut microbiome.

The team of researchers studied the gut microbiome of 1815 individuals. They looked at PPI users vs non-users. Of those sampled, 215 of them were taking a PPI at the time that a sample was taken. It was found that those taking the PPIs had lower microbial diversity compared to those not taking PPIs. They also found that bacteria usually found in the mouth was over-represented in the fecal samples of those taking PPIs, including those in the Rothia genus. They also observed an increase in Enterococcus, Streptococcus, Staphylococcus, and Escherichia coli, a potentially pathogenic bacterium.

PPI usage effects are more prominent than those of most other drugs, including antibiotics. The results of this study are consistent with a less healthy microbiome and allow us to better understand why PPIs may lead to an increase of susceptibility to intestinal infections like C. diff.

Clinical trial suggests dysbiosis may be involved in the progression of acute pancreatitis

The pancreas.  1: Head of pancreas 2: Uncinate process of pancreas 3: Pancreatic notch 4: Body of pancreas 5: Anterior surface of pancreas 6: Inferior surface of pancreas 7: Superior margin of pancreas 8: Anterior margin of pancreas 9: Inferior margin of pancreas 10: Omental tuber 11: Tail of pancreas 12: Duodenum

Acute pancreatitis is a sudden and severe inflammation of the pancreas.  It is responsible for many emergency room visits each year, but what causes its onset is unknown.  Most cases are mild, and can be treated with very passive measures, such as fasting or rehydration.  Other cases though (around 25%), are more severe, and require medical interventions, such as surgery.  Recently, researchers in China conducted a clinical trial on people with acute pancreatitis in order to figure out what, if any, connections existed between the microbiome this disease.  They published their results in the journal Pancreas.

The researchers sampled the feces and blood of 76 patients with acute pancreatitis every few days as the disease progressed (44 were severe cases and 32 were mild), along with 32 healthy controls.  They discovered a dramatic decrease in microbiome diversity occurred in those people with pancreatitis, which was characterized by an increase in Enterococcus and a decrease in bifidobacteria compared to controls.  In addition, pro-inflammatory molecules in the blood were directly correlated with the abundance of Enterococcus in these patients.

It is difficult to connect the microbiome to many inflammatory diseases because the mechanisms for how this occurs are still not totally understood.  Hence, many studies, like this one, are only able to show a correlation between the microbiome and these diseases.  Still though, these correlations can be powerful, and at the very least show the need for more research.  So while it may not be true that a dysbiosis causes acute pancreatitis, they are clearly associated.