The effect of H2-receptor antagonist and proton pump inhibitor on microbial proliferation in the stomach

Hepatogastroenterology. Sep-Oct 2004;51(59):1540-3.


Background/aims: Intra-gastric bacterial proliferation is frequent in patients with hypochlohydria. However, status of gastric bacterial infection in patients receiving proton pump inhibitor or H2-receptor antagonist remains controversial. The purpose of this study was to investigate the microbial condition of the stomach in patients who received H2-receptor antagonist or proton pump inhibitor.

Methodology: Between November 2000 and January 2002, 102 patients were enrolled in this study. Of these, 52 did not receive any treatment (group I), 26 received H2-receptor antagonist (group II), and 24 received proton pump inhibitor (group III). Ten mL of gastric juice were aspirated for culture during endoscopic examination. The aerobic and anaerobic bacterial and fungal cultures were performed immediately. A glass pH meter measured the pH of the gastric juice.

Results: The intra-gastric pH was 2.91+/-2.06 (mean +/- SD), 4.12+/-2.83, and 5.11+/-2.47 for groups I, II, and III, respectively (p=0.001 between groups I and III, p>0.05 between groups I and II, and groups II and III). The positive bacterial culture rates were 66.7% (16/24) in group III, 46.2% (12/26) in group II, and 28.8% (15/52) in group I (p=0.007 between groups III and I,p>0.05 between groups I and II, and groups II and III). The positive candidal culture rates were 12.5% (3/24) in group III, 11.5% (3/26) in group II, and 17.3% (9/52) in group I (p>0.05).

Conclusions: Patients who received proton pump inhibitor had more acid suppression and intra-gastric bacterial infection than those of the control group. The intra-gastric candidal infection was not related to intra-gastric pH or anti-secretory medication in this study.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Anti-Ulcer Agents / adverse effects
  • Anti-Ulcer Agents / therapeutic use*
  • Bacteria / growth & development*
  • Candida / growth & development*
  • Cimetidine / adverse effects
  • Cimetidine / therapeutic use*
  • Colony Count, Microbial
  • Colony-Forming Units Assay
  • Female
  • Gastric Acidity Determination*
  • Gastric Juice / microbiology*
  • Gastritis / drug therapy
  • Gastritis / microbiology
  • Gastroscopy
  • Histamine H2 Antagonists / adverse effects
  • Histamine H2 Antagonists / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Omeprazole / adverse effects
  • Omeprazole / therapeutic use*
  • Peptic Ulcer / drug therapy
  • Peptic Ulcer / microbiology
  • Proton Pump Inhibitors*
  • Ranitidine / adverse effects
  • Ranitidine / therapeutic use*
  • Risk Factors


  • Anti-Ulcer Agents
  • Histamine H2 Antagonists
  • Proton Pump Inhibitors
  • Cimetidine
  • Ranitidine
  • Omeprazole