Bowel symptoms in patients that receive proton pump inhibitors. Results of a multicenter survey in Mexico

Abstract

Introduction: Proton pump inhibitors (PPIs) have been associated with small intestinal bacterial overgrowth (SIBO), which increases with prolonged PPI use, and SIBO has been associated with irritable bowel syndrome (IBS).

Objective: The aim of the present study was to study the prevalence of bowel symptoms in patients treated with PPIs in Mexico.

Methods: Gastroenterologists in 36 cities surveyed patients treated with PPIs, utilizing an ad hoc questionnaire to determine the presence of bowel symptoms and IBS.

Results: Two hundred and fifteen physicians interviewed 1,851 patients. PPI indications were gastritis (48.8%), gastroesophageal reflux (38.5%), peptic ulcer (6.2%), and others (6.5%). A total of 77.5% of the patients received treatment for ≤6 months and 11.9% for ≥1 year. Symptoms were reported in 92.3% of the patients: abnormal bowel habits (90%), bloating (82%), abdominal pain (63%), flatulence (58%), and abdominal discomfort (53%). A total of 67.5% of the patients fit the Rome III criteria for IBS. Symptoms presented in 55.9% of the patients before PPI intake and in 44.1% of the patients after PPI use (P<.005). Constipation (63.8%) predominated in the former, and diarrhea (56.5%) in the latter (P<.0001). The treatments prescribed for managing those symptoms were antispasmodics, antibiotics, prokinetics, and antiflatulents, but patients stated greater satisfaction with antibiotics (mainly rifaximin) (P<.0001).

Conclusion: The association of PPIs with bowel symptoms and IBS is frequent in Mexico. Diarrhea and bloating predominate, and antibiotics produce the greatest treatment satisfaction, suggesting that SIBO or dysbiosis is the cause of the PPI-related bowel symptoms. However, that remains to be confirmed.

Keywords: Constipation; Diarrea; Diarrhea; Estreñimiento; Inhibidores de bomba de protones; Intestinal symptoms; Irritable bowel syndrome; Proton pump inhibitors; Rifaximin; Rifaximina; Síndrome de intestino irritable; Síntomas intestinales.