Washed microbiota transplantation reduces proton pump inhibitor dependency in nonerosive reflux disease

World J Gastroenterol. 2021 Feb 14;27(6):513-522. doi: 10.3748/wjg.v27.i6.513.


Background: The pathogenesis of gastroesophageal reflux disease (GERD) is closely associated with the intestinal bacteria composition and their metabolites.

Aim: To investigate whether washed microbiota transplantation (WMT) improves symptoms of nonerosive reflux disease (NERD) with proton pump inhibitor (PPI) dependency.

Methods: Patients with recurrent NERD and PPI dependency at the First Affiliated Hospital of Guangdong Pharmaceutical University from 2017 to 2018 were included and divided into a WMT or PPI group treated with PPI with/without WMT. The endpoint was NERD symptom frequency evaluated 1 mo after WMT using reflux disease questionnaire (RDQ) and GERD questionnaire (GERDQ) scores, remission time, PPI dose, and the examination of intestinal mucosal barrier function.

Results: In the WMT (n = 15) and PPI (n = 12) groups, the total remission rate at 1 mo after treatment was 93.3% vs 41.7%. Compared with the PPI group, the WMT group showed better results in GERDQ (P = 0.004) and RDQ (P = 0.003) and in remission months (8 vs 2, P = 0.002). The PPI dose was reduced to some extent for 80% of patients in the WMT group and 33.3% in the PPI group. In 24 patients, intestinal mucosal barrier function was examined before treatment, and changes in the degree of damage were observed in 13 of these patients after treatment. Only one of the 15 patients had minor side effects, including a mushy stool two or three times a day, which resolved on their own after 1 wk.

Conclusion: This study is the first to demonstrate that WMT may be safe and effective for relieving NERD symptoms and reducing PPI dependency and recurrence.

Keywords: Intestinal bacteria; Lipopolysaccharide; Nonerosive reflux disease; Proton pump inhibitor dependency; Small intestinal bacterial overgrowth; Washed microbiota transplantation.

MeSH terms

  • Esophagitis, Peptic*
  • Gastroesophageal Reflux* / diagnosis
  • Gastroesophageal Reflux* / therapy
  • Humans
  • Microbiota*
  • Proton Pump Inhibitors / therapeutic use
  • Surveys and Questionnaires


  • Proton Pump Inhibitors