Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2015; 21(22): 6817-6819
Published online Jun 14, 2015. doi: 10.3748/wjg.v21.i22.6817
What are the effects of proton pump inhibitors on the small intestine?
Shunji Fujimori
Shunji Fujimori, Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo 113-8603, Japan
Author contributions: Fujimori S wrote the paper.
Conflict-of-interest: The author has no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shunji Fujimori, MD, PhD, Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. s-fujimori@nms.ac.jp
Telephone: +81-3-38222131 Fax: +81-3-56851793
Received: January 23, 2015
Peer-review started: January 24, 2015
First decision: March 10, 2015
Revised: March 24, 2015
Accepted: April 16, 2015
Article in press: April 17, 2015
Published online: June 14, 2015
Abstract

Generally, proton-pump inhibitors (PPIs) have great benefit for patients with acid related disease with less frequently occurring side effects. According to a recent report, PPIs provoke dysbiosis of the small intestinal bacterial flora, exacerbating nonsteroidal anti-inflammatory drug-induced small intestinal injury. Several meta-analyses and systematic reviews have reported that patients treated with PPIs, as well as post-gastrectomy patients, have a higher frequency of small intestinal bacterial overgrowth (SIBO) compared to patients who lack the aforementioned conditions. Furthermore, there is insufficient evidence that these conditions induce Clostridium difficile infection. At this time, PPI-induced dysbiosis is considered a type of SIBO. It now seems likely that intestinal bacterial flora influence many diseases, such as inflammatory bowel disease, diabetes mellitus, obesity, non-alcoholic fatty liver disease, and autoimmune diseases. When attempting to control intestinal bacterial flora with probiotics, prebiotics, and fecal microbiota transplantation, etc., the influence of acid suppression therapy, especially PPIs, should not be overlooked.

Keywords: Proton-pump inhibitors, Nonsteroidal anti-inflammatory drug, Small intestine, Dysbiosis, Small intestinal bacterial overgrowth

Core tip: Proton-pump inhibitor (PPI) administration provokes dysbiosis of small intestinal bacterial flora, which exacerbates nonsteroidal anti-inflammatory drug-induced small intestinal injury. Dysbiosis is considered part of small intestinal bacterial overgrowth. Both PPI administration and gastrectomy increase the frequency of small intestinal bacterial overgrowth. Intestinal bacterial flora influence a number of systematic diseases. The influence of acid suppression therapy, especially PPIs, on small intestinal bacterial flora is worth noting.