Authors: Gregory L Austin Emily K Ward
Publish Date: 2015/04/10
Volume: 25, Issue: 6, Pages: 1070-1070
Abstract
We appreciate the interest and comments of Syu Huang and Chen on our article regarding the effect of PPI use on gut microbiome profiles and weight loss in patients undergoing laparoscopic RouxenY gastric bypass LRYGB 1 We also greatly appreciate their report on their own experience in evaluating the association of shortterm PPI use with weight gain Given that patients who take a PPI for gastroesophageal reflux disease are more likely to be obese the issue of whether PPI use is associated with weight gain or impaired weight loss is an important questionThe data presented by Syu et al are interesting and an important contribution to the literature in which there is a paucity of data Of note the population studied by Syu et al was considerably different compared to the bariatric surgery population included in our study First their cohort included only nonobese patients who had endoscopically proven Helicobacter pylorinegative gastric ulcers Second the gut microbiota was not studied in Syu’s cohort but it is an important distinguishing characteristic that may explain how PPI use influences weight change Nonobese patients have been shown to have a different gut microbiota profile compared to obese patients 2 Our study indicated that PPI users had an altered gut microbiome composition both before and after LRYGB that was associated with impaired weight loss Finally the mean age of the cohort of Syu et al was considerably older 638 versus 443 years and the proportion of females 29 versus 88 was lower compared to the patients in our study In a separate cohort we recently reported on the association of PPI use with suboptimal weight loss in 472 consecutive patients who underwent LRYGB a cohort whose demographics are also significantly different than those included in the study by Syu et al 3The effect of PPI use on body weight may vary significantly across groups with different characteristics and may depend upon an individual’s underlying propensity for obesity baseline gut microbiota as well as their age or gender We are exploring mechanisms that might explain how PPI use leads to weight gain Given the high prevalence of PPI use addressing these unresolved questions is of critical importance
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