长期维持质子泵抑制剂治疗对老年人小肠细菌过度生长的影响分析

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

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。

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.