Cross-sectional studycited by the Tayebat archiveabstract only checked A-PPI-15 standard review
PPIs change gut bacteria (TwinsUK)
Proton pump inhibitors alter the composition of the gut microbiota.
Overview
Jackson MA et al.. Gut 2016 · PMID 26719299 · DOI 10.1136/gutjnl-2015-310861
PPI users had fewer typical gut bacteria and more mouth bacteria in stool.
Does the study support the specific claim? Yes · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Microbiome with PPIs.
- How was the study done?
Twin cohort + replication.
- How many people, animals or samples were studied?
1,827.
- What was actually found?
Lower diversity, oral bacteria.
- How large was the observed effect?
not a single effect size
- What do the results mean in everyday life?
Explains infection risk.
- What are the study's limitations?
Composition only.
- What does it say about Elawady's specific claim?
Supports.
- Do the results apply to Germany and Europe?
UK.
- What can explicitly not be concluded from this study?
Disease causation.
Scientific in-depth review
1. Full reference
- Authors
- Jackson MA, Goodrich JK, Maxan ME, Freedberg DE, Abrams JA, Poole AC, Sutter JL, Welter D, Ley RE, Bell JT, Spector TD, Steves CJ
- Journal
- Gut
- Year
- 2016
- Identifier
- PMID 26719299 DOI 10.1136/gutjnl-2015-310861 · PMC4853574
- Verification
- verified – PubMed E-utilities efetch, 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract; grants: NCATS NIH HHS, NIDDK NIH HHS, NIH HHS, Wellcome Trust
2. Research question
Is PPI use associated with gut microbiome composition?
3. Study design and population
- Study design
- Cross-sectional study – Population-based twin cohort (TwinsUK) 16S rRNA analysis, with replication in an interventional study and discordant twin pairs
- Population
Healthy twins
- Country
UK
- Sample size
1,827 twins
- Inclusion and exclusion criteria
see abstract
4. Methods and endpoints
- Exposure / intervention
PPI use
- Comparator
Non-use
- Endpoints
Faecal microbiota composition and diversity
- Statistical methods
Association analyses, paired twin analysis
5. Actual results
- Results
Lower abundance of gut commensals and lower diversity in PPI users; more oral/upper-GI commensals (Streptococcaceae); replicated in interventional study and 70 discordant monozygotic twin pairs.
- Absolute risks
not reported in abstract
- Authors' conclusion
PPIs have a significant impact on the gut microbiome; caution over-use.
6. Strengths
- Large
- Replication incl. interventional data and twins
7. Weaknesses
- Composition change ≠ disease
- Cross-sectional main analysis
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Twin and interventional replication reduce confounding.
9. Assessment of the statistical interpretation
Modest relative risks from observational data; see bias notes.
10. Relevance to the specific claim
11. Independent contrary findings
Clinical consequences unclear.
12. Transferability to Germany and Europe
High: European (Swedish, UK, Dutch, German) data show similar associations; PPIs are widely used in Germany.
13. Overall methodological judgement
Robust finding of composition change.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | not applicable |
| Directness | indirect |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | correctly reported |
14. Open questions
15. Linked fact checks
Use by the Tayebat archive
Note: according to the archive, the studies were compiled by the archive operators. Whether Dr. Elawady himself cited this study is not established.
- What the archive says about the study
Listed in the archive bibliography of the acid-blockers rule without its own interpretation; used implicitly to support the rule summary ('long-term suppression turns against the body: CKD, bacterial overgrowth, C. difficile, pneumonia, B12 and magnesium deficiency, hip fractures, microbiome change, excess mortality').
- A. What was actually studied?
Is PPI use associated with gut microbiome composition?
- B. What did the authors find?
Lower abundance of gut commensals and lower diversity in PPI users; more oral/upper-GI commensals (Streptococcaceae); replicated in interventional study and 70 discordant monozygotic twin pairs.
- C. What conclusions do the authors themselves draw?
PPIs have a significant impact on the gut microbiome; caution over-use.
- D. What does the archive derive from it?
Supports 'microbiome change'.
- E. Is this derivation scientifically justified?
Yes for composition change.
- Adequacy of the interpretation (by the archive)
- correctly reported