Effects of long-term PPI treatment on producing bowel symptoms and SIBO

Authors

  • Debora Compare,

    1. Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples “Federico II”, Naples, Italy
    Search for more papers by this author
  • Loredana Pica,

    1. Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples “Federico II”, Naples, Italy
    Search for more papers by this author
  • Alba Rocco,

    1. Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples “Federico II”, Naples, Italy
    Search for more papers by this author
  • Francesco De Giorgi,

    1. Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples “Federico II”, Naples, Italy
    Search for more papers by this author
  • Rosario Cuomo,

    1. Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples “Federico II”, Naples, Italy
    Search for more papers by this author
  • Giovanni Sarnelli,

    1. Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples “Federico II”, Naples, Italy
    Search for more papers by this author
  • Marco Romano,

    1. Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Italy
    Search for more papers by this author
    •  M. Romano and G. Nardone contributed equally to this work.

  • Gerardo Nardone

    1. Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples “Federico II”, Naples, Italy
    Search for more papers by this author
    •  M. Romano and G. Nardone contributed equally to this work.


Gerardo Nardone, MD, Associate Professor of Gastroenterology, Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples “Federico II”, Via S. Pansini 5, 80131 Naples, Italy. Tel.: +39 081 7462158; fax: +39 081 74624293; e-mail: nardone@unina.it

Abstract

Eur J Clin Invest 2011; 41 (4): 380–386

Abstract

Background  Gastroesophageal reflux disease (GERD), including erosive reflux disease and non-erosive reflux disease (NERD), is a chronic disease with a significant negative effect on quality of life. State-of-the-art treatment involves proton pump inhibitors (PPIs). However, relapse of symptoms occurs in the majority of the patients who require recurrent or continuous therapy. Although PPIs are well tolerated, little information is available about gastrointestinal side effects.

Aim  To evaluate the effects of long-term PPI treatment on development of bowel symptoms and/or small intestinal bacterial overgrowth (SIBO).

Methods  Patients with NERD not complaining of bowel symptoms were selected by upper endoscopy, 24-h pH-metry and a structured questionnaire concerning severity and frequency of bloating, flatulence, abdominal pain, diarrhoea and constipation. Patients were treated with esomeprazole 20 mg bid for 6 months. Prior to and after 8 weeks and 6 months of therapy, patients received the structured questionnaire and underwent evaluation of SIBO by glucose hydrogen breath test (GHBT).

Results  Forty-two patients with NERD were selected out of 554 eligible patients. After 8 weeks of PPI treatment, patients complained of bloating, flatulence, abdominal pain and diarrhoea in 43%, 17%, 7% and 2%, respectively. After 6 months, the incidence of bowel symptoms further increased and GHBT was found positive in 11/42 (26%) patients. By a post hoc analysis, a significant (P < 0·05) percentage of patients (8/42) met Rome III criteria for irritable bowel syndrome.

Conclusions  Prolonged PPI treatment may produce bowel symptoms and SIBO; therefore, the strategy of step-down or on-demand PPI therapy should be encouraged in GERD.

Ancillary