Cross-sectional studycited by the Tayebat archiveabstract only checked A-PPI-16 standard review
PPIs and the gut microbiome (Netherlands)
Proton pump inhibitors affect the gut microbiome.
Overview
Imhann F et al.. Gut 2016 · PMID 26657899 · DOI 10.1136/gutjnl-2015-310376
PPI users had less diverse gut bacteria and more potentially harmful bacteria.
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.
- How was the study done?
3 cohorts.
- How many people, animals or samples were studied?
1,815.
- What was actually found?
Shifts in 20% of taxa.
- What do the results mean in everyday life?
Possible infection link.
- What are the study's limitations?
Cross-sectional.
- What does it say about Elawady's specific claim?
Supports.
- Do the results apply to Germany and Europe?
Dutch.
- What can explicitly not be concluded from this study?
Disease.
Scientific in-depth review
1. Full reference
- Authors
- Imhann F, Bonder MJ, Vich Vila A, Fu J, Mujagic Z, Vork L, Tigchelaar EF, Jankipersadsing SA, Cenit MC, Harmsen HJ, Dijkstra G, Franke L, Xavier RJ, Jonkers D, Wijmenga C, Weersma RK, Zhernakova A
- Journal
- Gut
- Year
- 2016
- Identifier
- PMID 26657899 DOI 10.1136/gutjnl-2015-310376 · PMC4853569
- 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: NIDDK NIH HHS
2. Research question
Influence of PPI use on gut microbiome
3. Study design and population
- Study design
- Cross-sectional study – Three population cohorts, 16S rRNA sequencing, meta-analysis
- Population
Three Dutch cohorts
- Country
Netherlands
- Sample size
1,815 (211 PPI users)
- Inclusion and exclusion criteria
see abstract
4. Methods and endpoints
- Exposure / intervention
Current PPI use
- Comparator
Non-use
- Endpoints
Microbiome diversity and taxa
- Statistical methods
Per-cohort analysis then meta-analysis; FDR
5. Actual results
- Results
Decreased Shannon diversity; changes in 20% of taxa; oral bacteria (Rothia, p=9.8×10⁻³⁸); more Enterococcus, Streptococcus, Staphylococcus, E. coli.
- Absolute risks
not reported in abstract
- Authors' conclusion
PPI-associated changes point toward a less healthy microbiome; effects more prominent than antibiotics at population level.
6. Strengths
- Three cohorts
- Meta-analysis
7. Weaknesses
- Cross-sectional
- Composition ≠ outcome
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
Cross-sectional; confounding possible.
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
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
Consistent with A-PPI-15.
| 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?
Influence of PPI use on gut microbiome
- B. What did the authors find?
Decreased Shannon diversity; changes in 20% of taxa; oral bacteria (Rothia, p=9.8×10⁻³⁸); more Enterococcus, Streptococcus, Staphylococcus, E. coli.
- C. What conclusions do the authors themselves draw?
PPI-associated changes point toward a less healthy microbiome; effects more prominent than antibiotics at population level.
- D. What does the archive derive from it?
Supports microbiome change.
- E. Is this derivation scientifically justified?
Yes.
- Adequacy of the interpretation (by the archive)
- correctly reported