The impacts of acid suppression on duodenal microbiota during the early phase of severe acute pancreatitis

Xiao Ma,Ling Liu,Zhiyin Huang,Jinsun Jiang,Qinghua Tan,Zhe Feng,Mingguang Zhang,Ming Zhou,Chengwei Tang,Jinhang Gao,Chong Zhao,Rui Liu,Libin Huang,Huan Tong

doi:10.1038/s41598-020-77245-1

Xiao Ma, Ling Liu + Show 12 more

Open Access

https://doi.org/10.1038/s41598-020-77245-1

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Abstract

Duodenal dysbiosis may be potential infection risks in patients with severe acute pancreatitis (SAP). Acid-suppression drugs (ACDs) are widely used in SAP patients in Asian countries. However, the impact of ACDs on duodenal microbiota during the early phase of SAP is still unknown. This randomized controlled clinical trial evaluated the impacts of esomeprazole (Eso), one of ACDs on duodenal microbiota during the first week of SAP with duodenal aspirates culture and 16sRNA Illumina sequencing analysis. 66 patients were randomized as 1:1 ratio into Eso group (Eso 40 mg/day) and Eso-N group (no Eso). The occurrence of duodenal bacterial overgrowth (DBO) was significantly higher in Eso group (about 85%) than that in Eso-N group (about 42%). The duodenal microbiota of the SAP patients shifted away from that of the normal control. There were differences between the Eso-N and Eso groups including enriched abundances of the class Negativicutes, order Selenomonadales and genus Veillonella. Acid suppression significantly increased incidence of Candida oesophagitis (CE) by 8-folds but did not increase other infectious events. In conclusion, acid suppression greatly increased the occurrence of DBO, duodenal dysbiosis and CE during the first week of SAP. Restrictive use of acid-suppressing medications might be helpful to reduce CE and potential risk of pancreatic infection in SAP patients.Trial registration: Chictr.org, ChiCTR-IPR-16008301, Registered April 18 2016, http://www.chictr.org.cn/showproj.aspx?proj=14089.

Highlights

Duodenal dysbiosis may be potential infection risks in patients with severe acute pancreatitis (SAP)
From April 2016 to March 2017, 67 patients were directly admitted to our hospital and were enrolled randomly into the Eso group and the Eso-N groups
SAP, which is characterized by the inflammatory cascade, often results in gut bacterial overgrowth, which in turn aggravates the disease through activation of the innate immune system or bacterial translocation 15–17

Summary

Introduction

Duodenal dysbiosis may be potential infection risks in patients with severe acute pancreatitis (SAP). Acid-suppression drugs (ACDs) are widely used in SAP patients in Asian countries. Acid suppression greatly increased the occurrence of DBO, duodenal dysbiosis and CE during the first week of SAP. Restrictive use of acid-suppressing medications might be helpful to reduce CE and potential risk of pancreatic infection in SAP patients. Several studies have reported that PPIs increase the risk of small intestinal bacteria overgrowth (SIBO) and alter the composition of gut microbiota[7,8,9]. It is worth noting that there is a positive correlation between duodenal bacteria overgrowth (DBO) and bacterial infections in experimental AP12. Duodenal dysbiosis and ASDs-associated CE in SAP patients are still largely unknown

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