PPI MethanePPI Methane.doc

Am J Gastroenterol.?2012 May;107(5):730-5. doi: 10.1038/ajg.2012.4. Epub 2012 Feb 14. Proton pump inhibitor therapy use does not predispose to small intestinal bacterial overgrowth. Ratuapli SK,?Ellington TG,?ONeill MT,?Umar SB,?Harris LA,?Foxx-Orenstein AE,?Burdick GE,?Dibaise JK,?Lacy BE,?Crowell MD. Source Division of Gastroenterology, Mayo Clinic, Scottsdale, Arizona, USA. Abstract OBJECTIVES: Small intestinal bacterial overgrowth (SIBO) occurs due to alteration of the microbiota within the upper gastrointestinal tract. Proton pump inhibitor (PPI) therapy has been suggested as a risk factor for SIBO; however, the published reports have yielded conflicting results on the association between?PPI?therapy and risk of developing SIBO. The aim of this study was to compare the prevalence of SIBO as measured by glucose hydrogen breath testing (GHBT) in patients on?PPI?therapy compared with those not on?PPI?therapy. METHODS: A retrospective chart review was completed for all patients who underwent GHBT testing from 2004 to 2010. Breath samples for hydrogen (H?) and?methane?(CH?) were collected before and every 20?min for 120?min following ingestion of a 50-g oral glucose load. We used the following criteria to define a positive GHBT (a) increase in H? 20 parts per million (p.p.m.) over baseline, (b) sustained rise H? 10?p.p.m. over baseline, (c) CH? 15?p.p.m. over baseline, and (d) either rise H? 20?p.p.m. over baseline or CH? 15?p.p.m. RESULTS: A total of 1,191 patients (70% female) were included, of whom 566 (48%) were on?PPI?therapy. GHBT positivity did not differ significantly between?PPI?users and nonusers by any of the diagnostic criteria used and?PPI?use was not significantly associated with GHBT positivity using any of these criteria. GHBT positivity was associated with older age (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01-1.04) and antidiarrheal use (OR 1.99, 95% CI 1.15-3.44) using H? 20, older age (OR 1.01, 95% CI 1.00-1.02) and diarrhea (OR