Proton pump inhibitors (PPIs) are a class of prescription drugs often used to manage acid reflux and ulcers. Growing research suggests that these acid suppressing medications have potential complications when taken long term. Concerns regarding PPIs include vitamin deficiencies, bone fractures, pneumonia and clostridium difficile infections. A new research study published in Microbiome has shown a potential cause for these complications. The trial investigated the gut flora in a small group of healthy patients given either low or high dose PPIs for 28 days. Stool samples showed a decrease in healthy gut bacteria both after one week and one month of PPI use. The decrease in gut flora was not dose dependent and was mostly reversible one month after discontinuation of medication. Interestingly, researchers found that the gut bacteria counts of subjects taking PPIs were similar to those with clostridium difficile infections.
Our digestive tract consists of trillions of healthy bacteria that aid in digestion, immune function and vitamin synthesis. This study is the first to demonstrate that PPI use reduces our gut flora counts which may account for many of the potential complications of long term PPI use. In our opinion these findings are promising but the small sample size limits strength of this study. More research is necessary to confirm these results. Furthermore, it is unclear if our healthy bacteria levels are affected by other types of antacid medications.
If you have mild reflux symptoms our advice is to try lifestyle modifications before taking medication. Portion control, weight management, reducing fat intake, and limiting alcohol can help reduce your symptoms. Keep a food diary to see what triggers your symptoms and then try to avoid these foods. Those who are taking PPIs should not stop their medication without consulting a health care provider. Despite the aforementioned complications of PPI use these drugs are consider very safe when used appropriately. Probiotics may play a vital role in reversing the effects of PPI use on gut flora and reducing reflux symptoms. Yogurt, fermented foods and probiotic supplements are good sources of these helpful microorganisms. Please consult with one of our nutritionists if you are unsure of which is best supplement for you.
Original research article can be found at Microbiome. Prolonged use of proton pump inhibitor reduces microbial diversity: implications for Clostridium difficule susceptibility.