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Aliment Pharmacol Ther. 1998 Jan;12(1):99-104.

Drug-induced hypochlorhydria causes high duodenal bacterial counts in the elderly.

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Gastroenterology Unit, Guy's Hospital Campus, Division of Medicine, UMDS, London, UK.



Small bowel bacterial overgrowth secondary to drug-induced hypochlorhydria may be of particular importance in the elderly, in whom anti-ulcer drugs are commonly prescribed and the consequences of malabsorption may be severe.


Duodenal aspirates were obtained from elderly individuals before (n = 24) and during a 2-month treatment course with either omeprazole (20 mg daily; n = 8) or ranitidine (300 mg b.d.; n = 6), and from six patients with small bowel bacterial overgrowth who had diarrhoea and malabsorption.


Before treatment, duodenal bacterial counts were normal (< 10(4) colony forming units/mL) in 23 elderly subjects (96%). However, six of 14 patients (43%) treated with omeprazole (5 of 8) or ranitidine (1 of 6) developed bacterial counts > 10(5) cfu/mL. All remained asymptomatic and had normal lactulose breath H2 profiles during treatment.


Drug-induced hypochlorhydria causes high duodenal bacterial counts in the elderly but, in the short term, this bacterial overgrowth is not associated with malabsorption.

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