Effects of proton pump inhibitor use on the esophageal microbial community
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RESEARCH ARTICLE
Open Access
Effects of proton pump inhibitor use on the esophageal microbial community Sadia Tasnim1, Aaron L. Miller2, Daniel C. Jupiter3, Catherine F. Hamilton1, Gabriel L. Reep4, Timothy S. Krill4, Richard B. Pyles2 and Ikenna C. Okereke1*
Abstract Background: Changes in the esophageal microbiome correlate with esophageal disease, but the effects of proton pump inhibitor (PPI) drugs are incompletely characterized. Our objective was to identify the effects of PPI use on the microbial community of the esophagus. Methods: Mucosal biopsies of the distal esophagus were analyzed using a customized esophageal microbiome qPCR panel array (EMB). Patient demographics, use of PPIs, duration of use and dose were recorded. Results: Fifty-eight patients were included. Mean age was 60.5 years. Ninety percent (52/58) of patients were on PPIs. Mean dose was 42.7 mg. Mean duration of use was 2.5 years. The use of PPIs led to a significant difference in absolute levels of only one organism, Actinomyces, in the entire array (p < 0.01). Among patients who used proton pump inhibitors, there was no significant association between dose and absolute levels of any organism. Similarly, there was no association between duration of use and absolute levels of any organism. Conclusions: PPI use does not seem to cause significant changes in the distal esophageal microbial community. Future studies with larger sample sizes and esophageal pH testing should be performed to determine the level of acidity and its relationship to the microbial community. Keywords: Microbiome, Proton pump inhibitor, Dose effect
Background Proton pump inhibitors (PPIs) are one of the most commonly used medications worldwide. They block the hydrogen-potassium ATPase receptor and inhibit gastric acid secretion by the parietal cell of the stomach. They are used to treat gastroesophageal reflux disease (GERD), prevent gastric and duodenal ulcers, treat Helicobacter pylori infections and many other diseases. PPIs have been known to change the gut microbiome and increase the incidence of Clostridium difficile, Campylobacter and Salmonella infections [1, 2]. However, the interaction between PPIs and the esophageal microbiome has not been properly * Correspondence: [email protected] 1 Division of Cardiothoracic Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA Full list of author information is available at the end of the article
explored. It has been hypothesized that PPI use can alter the esophageal microbiome in two ways. One potential mechanism is by altering the pH of the distal esophagus secondary to gastric acid production [3]. A second possible mechanism is by directly targeting the P-type ATPase bacterial proton pumps and changing the pH of the bacterial microenvironment [4]. The normal distal esophageal microbiome is dominated by gram-positive organisms, particularly Streptococcus [5]. A prior study noted a significant increase of organisms from the Lachnospiraceae, Comamonadaceae, and Clostridiaceae fam
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