You are here

J Pediatr DOI:10.1016/j.jpeds.2014.12.067

16S community profiling identifies proton pump inhibitor related differences in gastric, lung, and oropharyngeal microflora.

Publication TypeJournal Article
Year of Publication2015
AuthorsRosen, R, Hu, L, Amirault, J, Khatwa, U, Ward, DV, Onderdonk, A
JournalJ Pediatr
Date Published2015 Apr
KeywordsAdolescent, Bacteria, Bronchoalveolar Lavage Fluid, Bronchoscopy, Child, Child, Preschool, Cross-Sectional Studies, DNA, Bacterial, Electric Impedance, Endoscopy, Gastrointestinal, Esophageal pH Monitoring, Female, Follow-Up Studies, Gastroesophageal Reflux, Humans, Infant, Laryngoscopy, Lung, Male, Oropharynx, Prospective Studies, Proton Pump Inhibitors, Stomach

OBJECTIVES: To test the hypothesis that proton pump inhibitor (PPI) use results in changes in gastric microflora which, through full column reflux, results in lung and oropharyngeal microflora changes.

STUDY DESIGN: We performed a prospective, cross-sectional cohort study of 116 children (57 off and 59 on PPIs) undergoing simultaneous bronchoscopy and upper endoscopy for the evaluation of chronic cough. We performed 16S sequencing on gastric, bronchoalveolar lavage, and oropharyngeal fluid. Fifty patients also underwent multichannel intraluminal impedance testing.

RESULTS: Streptococcus was more abundant in the gastric fluid of patients taking PPIs, and there was a significant correlation with PPI dose (mg/kg/d) and abundance of gastric Streptococcus (P = .01). There was also a significant difference in the abundance of oropharyngeal Streptococcus in patients treated with PPI. Eight unique bacterial genera were found in the gastric and lung fluid but not in the oropharyngeal suggesting exchange between the 2 sites and 2 of the 8 (Lactococcus, Acinetobacter) were more abundant in patients with more full column reflux, suggesting direct aspiration. Principal component analysis revealed greater overlap between gastric and lung than oropharyngeal microflora.

CONCLUSIONS: PPI use was associated with differences in gastric, lung, and oropharyngeal microflora. Although microflora exchange can occur between all 3 sites, gastric and lung microflora are more closely related, and the mechanism of exchange between sites may be aspiration of full column reflux.


Alternate JournalJ. Pediatr.
PubMed ID25661411
PubMed Central IDPMC4380592
Grant ListK23 DK073713 / DK / NIDDK NIH HHS / United States
R03 DK089146 / DK / NIDDK NIH HHS / United States
R03DK089146 / DK / NIDDK NIH HHS / United States