[The effects of continuous proton pump inhibitor therapy on small intestinal bacterial overgrowth in elderly]

Zhonghua Nei Ke Za Zhi. 2020 Sep 1;59(9):706-710. doi: 10.3760/cma.j.cn112138-20191218-00823.
[Article in Chinese]


Objective: Long-term proton pump inhibitor(PPI) therapy may increase the risk of small intestinal bacterial overgrowth(SIBO). Few studies on the effect of on-demand and continuous PPI therapy are available in elderly. To investigate the prevalence of SIBO and the effect of on-demand and continuous PPI therapy on SIBO in elderly. Methods: A total of 200 elderly outpatients admitted to Department of Gastroenterology at the Second Medical Center of PLA General Hospital were enrolled and divided into 3 groups: continuous PPI group, on-demand PPI group and control group. SIBO was diagnosed according to methane and hydrogen lactulose breath test (LBT).The prevalence of SIBO in the 3 groups was analyzed. Results: The prevalence of SIBO was 71.5% in 200 elderly. PPI therapy and diabetes mellitus (DM) were independent risk factors for SIBO. The prevalence of SIBO was 77.1% (108/140) in elderly who underwent long-term PPI therapy and 58.3% (35/60) in those without PPI therapy (P<0.01).The prevalence of SIBO was significantly higher in continuous PPI therapy group than that in on-demand PPI group and control group(88.6% vs. 65.7% and 58.3%, all P<0.01).However, no significant difference was found in the prevalence of SIBO between on-demand PPI group and control group (P>0.05). In elderly who underwent long-term PPI therapy, the prevalence of SIBO increased significantly if administration time was longer than 61 months. Conclusions: SIBO usually occurs in elderly patients who receive continuous PPI rather than on-demand use. If elderly require long-term PPI therapy, on demand administration is suggested as long as primary diseases are properly treated.

目的: 长期维持质子泵抑制剂(PPI)治疗可能增加小肠细菌过度生长(SIBO)的风险,极少有研究关注老年人按需和长期维持PPI治疗对SIBO的影响。应用甲烷氢乳果糖呼气试验(LBT)研究老年人SIBO的患病率,探讨按需和长期维持PPI治疗对老年人罹患SIBO风险的影响。 方法: 回顾性分析2016年9月—2019年3月解放军总医院第二医学中心消化内科门诊的200例老年人,分为长期维持PPI治疗组、按需PPI治疗组和对照组,应用LBT检测SIBO的患病率,分析比较三组的SIBO患病率。 结果: 200例老年LBT受试者,SIBO患病率为71.5%(143/200)。PPI治疗和糖尿病(DM)是SIBO的独立危险因素。接受PPI治疗的老年人SIBO患病率为77.1%(108/140),未接受PPI治疗的老年人SIBO患病率为58.3%(35/60),差异有统计学意义(P<0.01)。长期维持PPI治疗组SIBO患病率显著高于按需PPI治疗组和对照组(88.6%、65.7%和58.3%,P值均<0.01)。按需PPI治疗组与对照组相比,SIBO患病率差异无统计学意义(P >0.05)。长期PPI治疗的老年人,PPI治疗时间>61个月者SIBO患病率明显升高。 结论: 老年人长期维持PPI治疗增加SIBO患病风险,而按需PPI治疗则不会增加其风险。因此如果老年人必须接受长期PPI治疗,在原发病许可的前提下,尽量按需服用,而不是每日持续服用。.

Keywords: Aged; Methane and hydrogen breath test; Proton pump inhibitors; Small intestinal bacterial overgrowth.

MeSH terms

  • Aged
  • Bacterial Infections* / drug therapy
  • Breath Tests
  • Humans
  • Intestine, Small
  • Lactulose
  • Proton Pump Inhibitors / therapeutic use*


  • Proton Pump Inhibitors
  • Lactulose