PPIs Increase Small Intestinal Bacterial Overgrowth Risk by 71%
Do Proton Pump Inhibitors Increase Risk of Small Intestinal Bacterial Overgrowth?
Yes, proton pump inhibitors moderately but significantly increase the risk of small intestinal bacterial overgrowth (SIBO) by approximately 71% according to this comprehensive meta-analysis. The increased risk appears related to PPI-induced changes in gastric acid levels that normally help prevent bacterial overgrowth in the small intestine.
Dr. Kumar’s Take
This meta-analysis adds another important consideration to the PPI risk-benefit equation. A 71% increased SIBO risk is clinically meaningful, especially since SIBO can cause symptoms that overlap with the original GERD symptoms - bloating, abdominal pain, and digestive issues. This creates a potential cycle where PPIs treat one problem but create another that might require additional treatment. It reinforces the importance of using PPIs judiciously and for appropriate durations.