PMID- 29872220
OWN - NLM
STAT- MEDLINE
DCOM- 20190909
LR  - 20190909
IS  - 1572-0241 (Electronic)
IS  - 0002-9270 (Linking)
VI  - 113
IP  - 8
DP  - 2018 Aug
TI  - Proton Pump Inhibitor Initiation and Withdrawal affects Gut Microbiota and 
      Readmission Risk in Cirrhosis.
PG  - 1177-1186
LID - 10.1038/s41395-018-0085-9 [doi]
AB  - OBJECTIVES: Cirrhosis is associated with gut microbial dysbiosis, high 
      readmissions and proton pump inhibitor (PPI) overuse, which could be 
      inter-linked. Our aim was to determine the effect of PPI use, initiation and 
      withdrawl on gut microbiota and readmissions in cirrhosis. METHODS: Four cohorts 
      were enrolled. Readmissions study: Cirrhotic inpatients were followed throughout 
      the hospitalization and 30/90-days post-discharge. PPI initiation, 
      withdrawal/continuation patterns were analyzed between those with/without 
      readmissions. Cross-sectional microbiota study: Cirrhotic outpatients and 
      controls underwent stool microbiota analysis. Beneficial autochthonous and 
      oral-origin taxa analysis vis-a-vis PPI use was performed. Longitudinal studies: 
      Two cohorts of decompensated cirrhotic outpatients were enrolled. Patients on 
      chronic unindicated PPI use were withdrawn for 14 days. Patients not on PPI were 
      started on omeprazole for 14 days. Microbial analysis for oral-origin taxa was 
      performed pre/post-intervention. RESULTS: Readmissions study: 343 inpatients (151 
      on admission PPI) were enrolled. 21 were withdrawn and 45 were initiated on PPI 
      resulting in a PPI use increase of 21%. PPIs were associated with higher 30 
      (p = 0.002) and 90-day readmissions (p = 0.008) independent of comorbidities, 
      medications, MELD and age. Cross-sectional microbiota: 137 cirrhotics (59 on PPI) 
      and 45 controls (17 on PPI) were included. PPI users regardless of cirrhosis had 
      higher oral-origin microbiota while cirrhotics on PPI had lower autochthonous 
      taxa compared to the rest. Longitudinal studies: Fifteen decompensated cirrhotics 
      tolerated omeprazole initiation with an increase in oral-origin microbial taxa 
      compared to baseline. PPIs were withdrawn from an additional 15 outpatients, 
      which resulted in a significant reduction of oral-origin taxa compared to 
      baseline. CONCLUSIONS: PPIs modulate readmission risk and microbiota composition 
      in cirrhosis, which responds to withdrawal. The systematic withdrawal and 
      judicious use of PPIs is needed from a clinical and microbiological perspective 
      in decompensated cirrhosis.
FAU - Bajaj, Jasmohan S
AU  - Bajaj JS
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Acharya, Chathur
AU  - Acharya C
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Fagan, Andrew
AU  - Fagan A
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - White, Melanie B
AU  - White MB
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Gavis, Edith
AU  - Gavis E
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Heuman, Douglas M
AU  - Heuman DM
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Hylemon, Phillip B
AU  - Hylemon PB
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Fuchs, Michael
AU  - Fuchs M
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Puri, Puneet
AU  - Puri P
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Schubert, Mitchell L
AU  - Schubert ML
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Sanyal, Arun J
AU  - Sanyal AJ
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Sterling, Richard K
AU  - Sterling RK
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Stravitz, Todd R
AU  - Stravitz TR
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Siddiqui, Mohammad S
AU  - Siddiqui MS
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Luketic, Velimir
AU  - Luketic V
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Lee, Hannah
AU  - Lee H
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Sikaroodi, Masoumeh
AU  - Sikaroodi M
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
FAU - Gillevet, Patrick M
AU  - Gillevet PM
AD  - Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and 
      McGuire VA Medical Center, Richmond, VA, USA. Microbiology, Virginia Commonwealth 
      University and McGuire VA Medical Center, Richmond, VA, USA. Microbiome Analysis 
      Center, George Mason University, Manassas, VA, USA.
LA  - eng
GR  - I01 BX001328/BX/BLRD VA/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20180606
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Cohort Studies
MH  - Drug Administration Schedule
MH  - Feces/microbiology
MH  - Female
MH  - Humans
MH  - *Liver Cirrhosis
MH  - Male
MH  - Microbiota
MH  - Middle Aged
MH  - *Patient Readmission
MH  - Proton Pump Inhibitors/*administration & dosage/adverse effects
MH  - Risk Factors
MH  - Virginia
EDAT- 2018/06/07 06:00
MHDA- 2019/09/10 06:00
CRDT- 2018/06/07 06:00
PHST- 2018/02/13 00:00 [received]
PHST- 2018/04/01 00:00 [accepted]
PHST- 2018/06/07 06:00 [pubmed]
PHST- 2019/09/10 06:00 [medline]
PHST- 2018/06/07 06:00 [entrez]
AID - 10.1038/s41395-018-0085-9 [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2018 Aug;113(8):1177-1186. doi: 10.1038/s41395-018-0085-9. 
      Epub 2018 Jun 6.