Suppression of gastric acid secretion in patients with gastroesophageal reflux disease results in gastric bacterial overgrowth and deconjugation of bile acids
(2000) In Journal of Gastrointestinal Surgery 4(1). p.4-50- Abstract
The aim of this study was to test the hypothesis that gastric bacterial overgrowth is a side effect of acid suppression therapy in patients with gastroesophageal reflux disease (GERD) and that the bacteria-contaminated gastric milieu is responsible for an increased amount of deconjugated bile acids. Thirty patients with GERD who were treated with 40 mg of omeprazole for at least 3 months and 10 patients with GERD who were off medication for at least 2 weeks were studied. At the time of upper endoscopy, 10 ml of gastric fluid was aspirated and analyzed for bacterial growth and bile acids. Bacterial overgrowth was defined by the presence of more than 1000 bacteria/ml. Bile acids were quantified via high-performance liquid chromatography.... (More)
The aim of this study was to test the hypothesis that gastric bacterial overgrowth is a side effect of acid suppression therapy in patients with gastroesophageal reflux disease (GERD) and that the bacteria-contaminated gastric milieu is responsible for an increased amount of deconjugated bile acids. Thirty patients with GERD who were treated with 40 mg of omeprazole for at least 3 months and 10 patients with GERD who were off medication for at least 2 weeks were studied. At the time of upper endoscopy, 10 ml of gastric fluid was aspirated and analyzed for bacterial growth and bile acids. Bacterial overgrowth was defined by the presence of more than 1000 bacteria/ml. Bile acids were quantified via high-performance liquid chromatography. Eleven of the 30 patients taking omeprazole had bacterial overgrowth compared to one of the 10 control patients. The median pH in the bacteria-positive patients was 5.3 compared to 2.6 in those who were free of bacteria and 3.5 in the control patients who were off medication. Bacterial overgrowth only occurred when the pH was >3.8. The ratio of conjugated to unconjugated bile acids changed from 4:1 in the patients without bacterial overgrowth to 1:3 in those with bacterial growth greater than 1000/ml. Proton pump inhibitor therapy in patients with GERD results in a high prevalence of gastric bacterial overgrowth. The presence of bacterial overgrowth markedly increases the concentration of unconjugated bile acids. These findings may have implications in the pathophysiology of gastroesophageal mucosal injury.
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- author
- Theisen, J ; Nehra, D ; Citron, D ; Johansson, Jan LU ; Hagen, J A ; Crookes, P F ; DeMeester, S R ; Bremner, C G ; DeMeester, T R and Peters, J H
- publishing date
- 2000-01-13
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Anti-Ulcer Agents/therapeutic use, Bile Acids and Salts/metabolism, Case-Control Studies, Chromatography, High Pressure Liquid, Female, Gastric Acid/metabolism, Gastroesophageal Reflux/drug therapy, Humans, Hydrogen-Ion Concentration, Male, Middle Aged, Omeprazole/therapeutic use, Proton Pump Inhibitors, Stomach/microbiology
- in
- Journal of Gastrointestinal Surgery
- volume
- 4
- issue
- 1
- pages
- 5 pages
- publisher
- Springer
- external identifiers
-
- pmid:10631362
- scopus:0033630511
- ISSN
- 1091-255X
- DOI
- 10.1016/S1091-255X(00)80032-3
- language
- English
- LU publication?
- no
- id
- 29767f5e-b746-4fcf-94b4-42736b8cdcd4
- date added to LUP
- 2019-05-26 16:57:48
- date last changed
- 2024-07-09 15:43:50
@article{29767f5e-b746-4fcf-94b4-42736b8cdcd4,
abstract = {{<p>The aim of this study was to test the hypothesis that gastric bacterial overgrowth is a side effect of acid suppression therapy in patients with gastroesophageal reflux disease (GERD) and that the bacteria-contaminated gastric milieu is responsible for an increased amount of deconjugated bile acids. Thirty patients with GERD who were treated with 40 mg of omeprazole for at least 3 months and 10 patients with GERD who were off medication for at least 2 weeks were studied. At the time of upper endoscopy, 10 ml of gastric fluid was aspirated and analyzed for bacterial growth and bile acids. Bacterial overgrowth was defined by the presence of more than 1000 bacteria/ml. Bile acids were quantified via high-performance liquid chromatography. Eleven of the 30 patients taking omeprazole had bacterial overgrowth compared to one of the 10 control patients. The median pH in the bacteria-positive patients was 5.3 compared to 2.6 in those who were free of bacteria and 3.5 in the control patients who were off medication. Bacterial overgrowth only occurred when the pH was >3.8. The ratio of conjugated to unconjugated bile acids changed from 4:1 in the patients without bacterial overgrowth to 1:3 in those with bacterial growth greater than 1000/ml. Proton pump inhibitor therapy in patients with GERD results in a high prevalence of gastric bacterial overgrowth. The presence of bacterial overgrowth markedly increases the concentration of unconjugated bile acids. These findings may have implications in the pathophysiology of gastroesophageal mucosal injury.</p>}},
author = {{Theisen, J and Nehra, D and Citron, D and Johansson, Jan and Hagen, J A and Crookes, P F and DeMeester, S R and Bremner, C G and DeMeester, T R and Peters, J H}},
issn = {{1091-255X}},
keywords = {{Anti-Ulcer Agents/therapeutic use; Bile Acids and Salts/metabolism; Case-Control Studies; Chromatography, High Pressure Liquid; Female; Gastric Acid/metabolism; Gastroesophageal Reflux/drug therapy; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Omeprazole/therapeutic use; Proton Pump Inhibitors; Stomach/microbiology}},
language = {{eng}},
month = {{01}},
number = {{1}},
pages = {{4--50}},
publisher = {{Springer}},
series = {{Journal of Gastrointestinal Surgery}},
title = {{Suppression of gastric acid secretion in patients with gastroesophageal reflux disease results in gastric bacterial overgrowth and deconjugation of bile acids}},
url = {{http://dx.doi.org/10.1016/S1091-255X(00)80032-3}},
doi = {{10.1016/S1091-255X(00)80032-3}},
volume = {{4}},
year = {{2000}},
}