Bacterial overgrowth common among long-term PPI users

In patients with gastroesophageal reflux disease (GERD), long-term use of proton pump inhibitors (PPI) contributes to bacterial overgrowth in the small intestine, in which the small bowel is colonized by large numbers of bacteria ordinarily found in the colon, produces bloating, diarrhea and other symptoms. The investigators used glucose hydrogen breath tests to look for small intestinal bacterial overgrowth in 450 consecutive patients enrolled in three groups: -- 200 GERD patients treated with PPIs for a median of 36 months; -- 200 patients with irritable bowel syndrome (IBS) who had not used PPIs for at least 3 years; and -- 50 healthy controls who had not used PPIs for at least 10 years.

According to their article published in Clinical Gastroenterology and Hepatology, they found small intestinal bacterial overgrowth in 50% of the PPI users with GERD, 24.5% of the IBS patients, and 6% of the healthy controls.

All subjects with small intestinal bacterial overgrowth were given high-dose rifaximin for 2 weeks. Treatment was successful in 87% of cases in the PPI group and in 91% of cases in the IBS group. The authors suggest that PPI-related small intestinal bacterial overgrowth may be under-diagnosed because the symptoms overlap with those of other gastrointestinal disorders.

Steve - maybe infusing these subjects with some healthy bacteria (probiotics) would help. Obviously, not relying on the PPIs is the best scenario.