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What is Gluten and Dairy Intolerance? What is the difference between an allergy and intolerance/sensitivity. Latest medical research. Open to the public.
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TOPIC: Proton Pump Inhibitors PPI's role in SIBO

Proton Pump Inhibitors PPI's role in SIBO 01 May 2013 16:11 #9275

  • Debra
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People who are gluten intolerant are frequently on proton pump inhibitors due to treat GERD. There are many problems that can arrise from reducing stomach acid. Vitamin B12 is one but now small intestinal bacteria overgrowth SBIO is another. Just published, this study free-full text, explains an increase in SBIO in those who take PPI's:

www.cghjournal.org/article/S1542-3565%2812%2901511-X/fulltext

Background & Aims
Use of proton pump inhibitors (PPIs) could predispose individuals to small intestinal bacterial overgrowth (SIBO) by altering the intraluminal environment and bacterial flora. There is controversy regarding the risk of SIBO among PPI users because of conflicting results from prior studies. A systematic review and meta-analysis were performed to evaluate the association between PPI use and SIBO, using objective clinical outcome measures.
Methods
Clinical studies comparing SIBO risk among adult users of PPIs vs nonusers were identified in MEDLINE/PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and the National Institutes of Health Clinical Trials databases through July 2012. Two reviewers independently extracted data on study characteristics and outcomes. The primary metameter was the odds ratio (OR) of SIBO among PPI users vs nonusers. Subgroup analyses were performed to examine the influence of study characteristics, such as SIBO diagnostic modality, on study outcome.

Results
Eleven studies (n = 3134) met inclusion criteria. The pooled OR of SIBO in PPI users vs nonusers was 2.282 (95% confidence interval [CI], 1.238–4.205). No significant single large study or temporal effect was seen. Subgroup analysis revealed an association between SIBO and PPI use in studies that used duodenal or jejunal aspirate cultures to diagnose SIBO (OR, 7.587; 95% CI, 1.805–31.894), but no relationship was found between SIBO and PPI use in studies that used the glucose hydrogen breath test (OR, 1.93; 95% CI, 0.69–5.42). Funnel plot analysis identified 4 outlying studies, indicating the possible presence of publication bias.

Conclusions
PPI use statistically was associated with SIBO risk, but only when the diagnosis was made by a highly accurate test (duodenal or jejunal aspirate culture). Differences in study results could arise from the use of different tests to diagnose SIBO.

Keywords: Hypochlorhydria , Drug , Small Bowel Flora , Reflux , Side Effect

Abbreviations used in this paper: CI, confidence interval, GHBT, glucose hydrogen breath test, OR, odds ratio, PPI, proton pump inhibitor, SIBO, small intestinal bacterial overgrowth
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