A Study on the Glucose Breath Test Positivity Rate and Occurrence of Small Intestine Bacterial Overgrowth-Related Symptoms Caused by Long-Term Use of Proton Pump Inhibitor (PPI) Versus Potassium-Competitive Acid Blocker (P-CAB) in Elderly Patients

Background/Aims: Long‐term acid suppression with proton pump inhibitors (PPI) leads to hypochlorhydria and facilitates the growth of bacterial flora in the small intestine. Novel acid‐suppressants called potassium‐competitive acid blockers (P‐CABs) seem to be superior to PPIs. However, data on the risk of small intestinal bacterial overgrowth (SIBO) in patients taking P‐CABs are limited. Method: We retrospectively analyzed a consecutive series of patients with long‐term acid‐suppressant (PPIs or P‐CABs) use for gastroesophageal reflux disease or nonsteroidal anti‐inflammatory drug (NSAID)‐induced gastropathy. All of them underwent endoscopic examinations and Helicobacter pylori testing and took PPIs or P‐CABs for at least 3 months. Glucose hydrogen breath tests (GBT) were performed to check for SIBO, and newly developed SIBO‐related symptoms including bloating, postprandial discomfort, diarrheas, and constipation, were evaluated. Results: A total of 142 patients were enrolled. Six patients were excluded due to equivocal Helicobacter pylori infection results. The frequency of positive GBTs was 31.7% (25/79) for PPI and 22.8% (13/57) for P‐CAB use ( p = 0.15). Regarding GBT positivity, age‐related factor was found to be significant in multivariate analysis ( p = 0.02). The results of multivariate analysis in cases of SIBO‐related symptoms showed that GBT positivity and PPI use were significant ( p < 0.01). Conclusion: Long‐term use of gastric acid suppressants resulted in positive GBT in approximately 30% of patients, and the risk was particularly high in elderly patients. The occurrence of SIBO‐related symptoms was significant in long‐term use of PPIs and in patients with positive GBT.

Abstract licence: CC BY

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