Acid suppression therapy leads to gastric bacterial overgrowth

Investigators set out to determine the impact of acid suppression therapy on the abundance and diversity of gastric and lung microflora in children with chronic cough by conducting a 5-year prospective study of 99 children aged from 1 to 18 years who were undergoing evaluative endoscopy and bronchoscopy. About half of patients received acid-suppression therapy, generally a proton pump inhibitor (PPI), and the other half did not.

Analysis of bronchoalveolar lavage and gastric samples taken during the procedures showed that 46% of children receiving acid-suppression therapy had gastric bacterial growth compared with 18% of untreated patients. In addition, acid suppression was associated with an increased prevalence and concentration of potential pathogens in the gastric fluid, including Staphylococcus and Streptococus, as well as Dermabacter and Rothia. In the lungs, however, the prevalence of different bacteria or concentrations of total bacteria did not differ between treated and untreated patients (Rosen R, et al. JAMA Pediatr. 2014:168[10]:932-937).

Commentary: How often do you treat gastroesophaphageal reflux (GER) with PPIs? This article is one more of many recent studies showing possible risks of this therapy, a therapy for which there is little evidence of efficacy.

A 2009 practice guideline on the diagnosis and treatment of GER and GER disease recommends acid suppression in only a very small segment of patients and, for many of these, only for a limited time. Nonetheless, authors of an accompanying editorial cite evidence that about 36% of pediatricians prescribe PPIs for uncomplicated regurgitation and, overall, 82% of pediatricians overprescribe these medications. Like cold medications in toddlers, this therapy may be an example of risk without true benefit (JAMA Pediatr. 2014;168[10]:888-890). -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.