The impact of proton pump inhibitors on the human gastrointestinal microbiome.

The impact of proton pump inhibitors on the human gastrointestinal microbiome.
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DOI:
10.1016/j.cll.2014.08.008
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发表时间:
2014-12
影响因子:
1.7
通讯作者:
Abrams JA
Abrams JA
中科院分区:
医学4区
文献类型:
--
作者:
Freedberg DE;Lebwohl B;Abrams JA

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使用质子泵抑制剂(PPI)的强效胃酸抑制在临床实践中很常见,但可能对人体健康产生重要影响,这些影响是通过胃肠道微生物组的变化介导的。PPI通过pH依赖性或pH非依赖性机制发挥作用,有可能改变整个人体胃肠道腔的正常微生物群。在食管中,PPI改变正常的细菌环境,以减少远端食管暴露于炎性革兰氏阴性菌,这可能降低巴雷特食管的风险。在胃中,PPI改变胃幽门螺杆菌和其他细菌的丰度和位置,这与消化性溃疡疾病和胃恶性肿瘤有关。在小肠中,PPI导致多微生物小肠细菌过度生长,并与乳糜泻的诊断相关。在结肠中,PPI与偶发但非复发性艰难梭菌感染相关,通过直肠结肠厌氧菌的改变而发生脓毒症。我们对胃酸抑制对人类胃肠道微生物组的影响的理解是不完整的,但正在迅速推进。
Potent gastric acid suppression using proton pump inhibitors (PPIs) is common in clinical practice yet may have important effects on human health that are mediated through changes in the gastrointestinal microbiome. Acting through pH-dependent or pH-independent mechanisms, PPIs have the potential to alter the normal microbiota throughout the human gastrointestinal lumen. In the esophagus, PPIs change the normal bacterial milieu to decrease distal esophageal exposure to inflammatory Gram-negative bacteria which may lower the risk of Barrett's esophagus. In the stomach, PPIs alter the abundance and location of gastric Helicobacter pylori and other bacteria, which has implications for peptic ulcer disease and gastric malignancy. In the small bowel, PPIs cause polymicrobial small bowel bacterial overgrowth and have been associated with the diagnosis of celiac disease. In the colon, PPIs associate with incident but not recurrent Clostridium difficile infection, putatively through alterations in commensal colonic anaerobes. Our understanding of the effect of gastric acid suppression on the human gastrointestinal microbiome is incomplete but is rapidly advancing.
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