Gut Microbiota Composition Before and After Use of Proton Pump Inhibitors
Background Recently, problems associated with proton pump inhibitor (PPI) use have begun to surface. PPIs influence the gut microbiota; therefore, PPI use may increase the risk of enteric infections and cause bacterial translocation. In this study, we investigated fecal microbiota composition, fecal...
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| Veröffentlicht in: | Digestive diseases and sciences 2018-11, Vol.63 (11), p.2940-2949 |
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| creator | Hojo, Mariko Asahara, Takashi Nagahara, Akihito Takeda, Tsutomu Matsumoto, Kohei Ueyama, Hiroya Matsumoto, Kenshi Asaoka, Daisuke Takahashi, Takuya Nomoto, Koji Yamashiro, Yuichiro Watanabe, Sumio |
| description | Background
Recently, problems associated with proton pump inhibitor (PPI) use have begun to surface. PPIs influence the gut microbiota; therefore, PPI use may increase the risk of enteric infections and cause bacterial translocation. In this study, we investigated fecal microbiota composition, fecal organic acid concentrations and pH, and gut bacteria in the blood of the same patients before and after PPI use.
Methods
Twenty patients with reflux esophagitis based on endoscopic examination received 8 weeks of treatment with PPIs. To analyze fecal microbiota composition and gut bacteria in blood and organic acid concentrations, 16S and 23S rRNA-targeted quantitative RT-PCR and high-performance liquid chromatography were conducted.
Results
Lactobacillus
species were significantly increased at both 4 and 8 weeks after PPI treatment compared with bacterial counts before treatment (
P
= 0.011 and
P
= 0.002, respectively). Among
Lactobacillus
spp., counts of the
L. gasseri
subgroup,
L. fermentum
, the
L. reuteri
subgroup, and the
L. ruminis
subgroup were significantly increased at 4 and 8 weeks after treatment compared with counts before treatment.
Streptococcus
species were also significantly increased at 4 and 8 weeks after PPI treatment compared with counts before treatment (
P
|
| doi_str_mv | 10.1007/s10620-018-5122-4 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6182435</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A712937386</galeid><sourcerecordid>A712937386</sourcerecordid><originalsourceid>FETCH-LOGICAL-c603t-544280f4d04de1a933ab66602c33d19811b87f594c594b28c0aacc5d80e8a24e3</originalsourceid><addsrcrecordid>eNp1kV9vFCEUxYnR2LX6AXwxJL74MpXLv2FeTLYbrZvU2Af7TBgGtjQzsMKMid9eNltbazSEQLi_c-ByEHoN5AwIad8XIJKShoBqBFDa8CdoBaJlDRVSPUUrArLuAeQJelHKLSGka0E-Rye0azvZAazQ9mKZ8Zdgc-pDmg3epGmfSphDivjc-ZQdNnHAaz-7jK-Lw8njq5zmWr5apj3expvQhznl8hI982Ys7tXdeoquP338tvncXH692G7Wl42VhM2N4Jwq4vlA-ODAdIyZXkpJqGVsgE4B9Kr1ouO2zp4qS4yxVgyKOGUod-wUfTj67pd-coN1cc5m1PscJpN_6mSCflyJ4Ubv0g8tQVHORDV4d2eQ0_fFlVlPoVg3jia6tBRNCRe0Bc6gom__Qm_TkmNt70DRTtD6_gdqZ0anQ_Sp3msPpnrdQkVapmSlzv5B1TG4KdgUnQ_1_JEAjoIaTinZ-fsegehD_vqYv67560P-mlfNmz8_517xO_AK0CNQainuXH7o6P-uvwCr7Lhe</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2042952933</pqid></control><display><type>article</type><title>Gut Microbiota Composition Before and After Use of Proton Pump Inhibitors</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Hojo, Mariko ; Asahara, Takashi ; Nagahara, Akihito ; Takeda, Tsutomu ; Matsumoto, Kohei ; Ueyama, Hiroya ; Matsumoto, Kenshi ; Asaoka, Daisuke ; Takahashi, Takuya ; Nomoto, Koji ; Yamashiro, Yuichiro ; Watanabe, Sumio</creator><creatorcontrib>Hojo, Mariko ; Asahara, Takashi ; Nagahara, Akihito ; Takeda, Tsutomu ; Matsumoto, Kohei ; Ueyama, Hiroya ; Matsumoto, Kenshi ; Asaoka, Daisuke ; Takahashi, Takuya ; Nomoto, Koji ; Yamashiro, Yuichiro ; Watanabe, Sumio</creatorcontrib><description>Background
Recently, problems associated with proton pump inhibitor (PPI) use have begun to surface. PPIs influence the gut microbiota; therefore, PPI use may increase the risk of enteric infections and cause bacterial translocation. In this study, we investigated fecal microbiota composition, fecal organic acid concentrations and pH, and gut bacteria in the blood of the same patients before and after PPI use.
Methods
Twenty patients with reflux esophagitis based on endoscopic examination received 8 weeks of treatment with PPIs. To analyze fecal microbiota composition and gut bacteria in blood and organic acid concentrations, 16S and 23S rRNA-targeted quantitative RT-PCR and high-performance liquid chromatography were conducted.
Results
Lactobacillus
species were significantly increased at both 4 and 8 weeks after PPI treatment compared with bacterial counts before treatment (
P
= 0.011 and
P
= 0.002, respectively). Among
Lactobacillus
spp., counts of the
L. gasseri
subgroup,
L. fermentum
, the
L. reuteri
subgroup, and the
L. ruminis
subgroup were significantly increased at 4 and 8 weeks after treatment compared with counts before treatment.
Streptococcus
species were also significantly increased at 4 and 8 weeks after PPI treatment compared with counts before treatment (
P
< 0.01 and
P
< 0.001, respectively). There was no significant difference in the total organic acid concentrations before and after PPI treatment. Detection rates of bacteria in blood before and after PPI treatment were 22 and 28%, respectively, with no significant differences.
Conclusions
Our quantitative RT-PCR results showed that gut dysbiosis was caused by PPI use, corroborating previous results obtained by metagenomic analysis.</description><identifier>ISSN: 0163-2116</identifier><identifier>EISSN: 1573-2568</identifier><identifier>DOI: 10.1007/s10620-018-5122-4</identifier><identifier>PMID: 29796911</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Aged ; Bacteria ; Biochemistry ; Blood - microbiology ; Carboxylic Acids - analysis ; Care and treatment ; Dysbiosis - chemically induced ; Feces ; Feces - chemistry ; Feces - microbiology ; Female ; Gastroenterology ; Gastroesophageal reflux ; Gastrointestinal Microbiome - drug effects ; Health aspects ; Hepatology ; High performance liquid chromatography ; Humans ; Infection ; Male ; Medical colleges ; Medicine ; Medicine & Public Health ; Microbiota ; Microbiota (Symbiotic organisms) ; Middle Aged ; Oncology ; Original ; Original Article ; Proton pump inhibitors ; Proton Pump Inhibitors - adverse effects ; Protons ; RNA ; Transplant Surgery</subject><ispartof>Digestive diseases and sciences, 2018-11, Vol.63 (11), p.2940-2949</ispartof><rights>The Author(s) 2018</rights><rights>COPYRIGHT 2018 Springer</rights><rights>Digestive Diseases and Sciences is a copyright of Springer, (2018). All Rights Reserved. © 2018. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c603t-544280f4d04de1a933ab66602c33d19811b87f594c594b28c0aacc5d80e8a24e3</citedby><cites>FETCH-LOGICAL-c603t-544280f4d04de1a933ab66602c33d19811b87f594c594b28c0aacc5d80e8a24e3</cites><orcidid>0000-0001-9671-5585</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10620-018-5122-4$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10620-018-5122-4$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29796911$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hojo, Mariko</creatorcontrib><creatorcontrib>Asahara, Takashi</creatorcontrib><creatorcontrib>Nagahara, Akihito</creatorcontrib><creatorcontrib>Takeda, Tsutomu</creatorcontrib><creatorcontrib>Matsumoto, Kohei</creatorcontrib><creatorcontrib>Ueyama, Hiroya</creatorcontrib><creatorcontrib>Matsumoto, Kenshi</creatorcontrib><creatorcontrib>Asaoka, Daisuke</creatorcontrib><creatorcontrib>Takahashi, Takuya</creatorcontrib><creatorcontrib>Nomoto, Koji</creatorcontrib><creatorcontrib>Yamashiro, Yuichiro</creatorcontrib><creatorcontrib>Watanabe, Sumio</creatorcontrib><title>Gut Microbiota Composition Before and After Use of Proton Pump Inhibitors</title><title>Digestive diseases and sciences</title><addtitle>Dig Dis Sci</addtitle><addtitle>Dig Dis Sci</addtitle><description>Background
Recently, problems associated with proton pump inhibitor (PPI) use have begun to surface. PPIs influence the gut microbiota; therefore, PPI use may increase the risk of enteric infections and cause bacterial translocation. In this study, we investigated fecal microbiota composition, fecal organic acid concentrations and pH, and gut bacteria in the blood of the same patients before and after PPI use.
Methods
Twenty patients with reflux esophagitis based on endoscopic examination received 8 weeks of treatment with PPIs. To analyze fecal microbiota composition and gut bacteria in blood and organic acid concentrations, 16S and 23S rRNA-targeted quantitative RT-PCR and high-performance liquid chromatography were conducted.
Results
Lactobacillus
species were significantly increased at both 4 and 8 weeks after PPI treatment compared with bacterial counts before treatment (
P
= 0.011 and
P
= 0.002, respectively). Among
Lactobacillus
spp., counts of the
L. gasseri
subgroup,
L. fermentum
, the
L. reuteri
subgroup, and the
L. ruminis
subgroup were significantly increased at 4 and 8 weeks after treatment compared with counts before treatment.
Streptococcus
species were also significantly increased at 4 and 8 weeks after PPI treatment compared with counts before treatment (
P
< 0.01 and
P
< 0.001, respectively). There was no significant difference in the total organic acid concentrations before and after PPI treatment. Detection rates of bacteria in blood before and after PPI treatment were 22 and 28%, respectively, with no significant differences.
Conclusions
Our quantitative RT-PCR results showed that gut dysbiosis was caused by PPI use, corroborating previous results obtained by metagenomic analysis.</description><subject>Aged</subject><subject>Bacteria</subject><subject>Biochemistry</subject><subject>Blood - microbiology</subject><subject>Carboxylic Acids - analysis</subject><subject>Care and treatment</subject><subject>Dysbiosis - chemically induced</subject><subject>Feces</subject><subject>Feces - chemistry</subject><subject>Feces - microbiology</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gastroesophageal reflux</subject><subject>Gastrointestinal Microbiome - drug effects</subject><subject>Health aspects</subject><subject>Hepatology</subject><subject>High performance liquid chromatography</subject><subject>Humans</subject><subject>Infection</subject><subject>Male</subject><subject>Medical colleges</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Microbiota</subject><subject>Microbiota (Symbiotic organisms)</subject><subject>Middle Aged</subject><subject>Oncology</subject><subject>Original</subject><subject>Original Article</subject><subject>Proton pump inhibitors</subject><subject>Proton Pump Inhibitors - adverse effects</subject><subject>Protons</subject><subject>RNA</subject><subject>Transplant Surgery</subject><issn>0163-2116</issn><issn>1573-2568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kV9vFCEUxYnR2LX6AXwxJL74MpXLv2FeTLYbrZvU2Af7TBgGtjQzsMKMid9eNltbazSEQLi_c-ByEHoN5AwIad8XIJKShoBqBFDa8CdoBaJlDRVSPUUrArLuAeQJelHKLSGka0E-Rye0azvZAazQ9mKZ8Zdgc-pDmg3epGmfSphDivjc-ZQdNnHAaz-7jK-Lw8njq5zmWr5apj3expvQhznl8hI982Ys7tXdeoquP338tvncXH692G7Wl42VhM2N4Jwq4vlA-ODAdIyZXkpJqGVsgE4B9Kr1ouO2zp4qS4yxVgyKOGUod-wUfTj67pd-coN1cc5m1PscJpN_6mSCflyJ4Ubv0g8tQVHORDV4d2eQ0_fFlVlPoVg3jia6tBRNCRe0Bc6gom__Qm_TkmNt70DRTtD6_gdqZ0anQ_Sp3msPpnrdQkVapmSlzv5B1TG4KdgUnQ_1_JEAjoIaTinZ-fsegehD_vqYv67560P-mlfNmz8_517xO_AK0CNQainuXH7o6P-uvwCr7Lhe</recordid><startdate>20181101</startdate><enddate>20181101</enddate><creator>Hojo, Mariko</creator><creator>Asahara, Takashi</creator><creator>Nagahara, Akihito</creator><creator>Takeda, Tsutomu</creator><creator>Matsumoto, Kohei</creator><creator>Ueyama, Hiroya</creator><creator>Matsumoto, Kenshi</creator><creator>Asaoka, Daisuke</creator><creator>Takahashi, Takuya</creator><creator>Nomoto, Koji</creator><creator>Yamashiro, Yuichiro</creator><creator>Watanabe, Sumio</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-9671-5585</orcidid></search><sort><creationdate>20181101</creationdate><title>Gut Microbiota Composition Before and After Use of Proton Pump Inhibitors</title><author>Hojo, Mariko ; Asahara, Takashi ; Nagahara, Akihito ; Takeda, Tsutomu ; Matsumoto, Kohei ; Ueyama, Hiroya ; Matsumoto, Kenshi ; Asaoka, Daisuke ; Takahashi, Takuya ; Nomoto, Koji ; Yamashiro, Yuichiro ; Watanabe, Sumio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c603t-544280f4d04de1a933ab66602c33d19811b87f594c594b28c0aacc5d80e8a24e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Bacteria</topic><topic>Biochemistry</topic><topic>Blood - microbiology</topic><topic>Carboxylic Acids - analysis</topic><topic>Care and treatment</topic><topic>Dysbiosis - chemically induced</topic><topic>Feces</topic><topic>Feces - chemistry</topic><topic>Feces - microbiology</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gastroesophageal reflux</topic><topic>Gastrointestinal Microbiome - drug effects</topic><topic>Health aspects</topic><topic>Hepatology</topic><topic>High performance liquid chromatography</topic><topic>Humans</topic><topic>Infection</topic><topic>Male</topic><topic>Medical colleges</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Microbiota</topic><topic>Microbiota (Symbiotic organisms)</topic><topic>Middle Aged</topic><topic>Oncology</topic><topic>Original</topic><topic>Original Article</topic><topic>Proton pump inhibitors</topic><topic>Proton Pump Inhibitors - adverse effects</topic><topic>Protons</topic><topic>RNA</topic><topic>Transplant Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hojo, Mariko</creatorcontrib><creatorcontrib>Asahara, Takashi</creatorcontrib><creatorcontrib>Nagahara, Akihito</creatorcontrib><creatorcontrib>Takeda, Tsutomu</creatorcontrib><creatorcontrib>Matsumoto, Kohei</creatorcontrib><creatorcontrib>Ueyama, Hiroya</creatorcontrib><creatorcontrib>Matsumoto, Kenshi</creatorcontrib><creatorcontrib>Asaoka, Daisuke</creatorcontrib><creatorcontrib>Takahashi, Takuya</creatorcontrib><creatorcontrib>Nomoto, Koji</creatorcontrib><creatorcontrib>Yamashiro, Yuichiro</creatorcontrib><creatorcontrib>Watanabe, Sumio</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Digestive diseases and sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hojo, Mariko</au><au>Asahara, Takashi</au><au>Nagahara, Akihito</au><au>Takeda, Tsutomu</au><au>Matsumoto, Kohei</au><au>Ueyama, Hiroya</au><au>Matsumoto, Kenshi</au><au>Asaoka, Daisuke</au><au>Takahashi, Takuya</au><au>Nomoto, Koji</au><au>Yamashiro, Yuichiro</au><au>Watanabe, Sumio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Gut Microbiota Composition Before and After Use of Proton Pump Inhibitors</atitle><jtitle>Digestive diseases and sciences</jtitle><stitle>Dig Dis Sci</stitle><addtitle>Dig Dis Sci</addtitle><date>2018-11-01</date><risdate>2018</risdate><volume>63</volume><issue>11</issue><spage>2940</spage><epage>2949</epage><pages>2940-2949</pages><issn>0163-2116</issn><eissn>1573-2568</eissn><abstract>Background
Recently, problems associated with proton pump inhibitor (PPI) use have begun to surface. PPIs influence the gut microbiota; therefore, PPI use may increase the risk of enteric infections and cause bacterial translocation. In this study, we investigated fecal microbiota composition, fecal organic acid concentrations and pH, and gut bacteria in the blood of the same patients before and after PPI use.
Methods
Twenty patients with reflux esophagitis based on endoscopic examination received 8 weeks of treatment with PPIs. To analyze fecal microbiota composition and gut bacteria in blood and organic acid concentrations, 16S and 23S rRNA-targeted quantitative RT-PCR and high-performance liquid chromatography were conducted.
Results
Lactobacillus
species were significantly increased at both 4 and 8 weeks after PPI treatment compared with bacterial counts before treatment (
P
= 0.011 and
P
= 0.002, respectively). Among
Lactobacillus
spp., counts of the
L. gasseri
subgroup,
L. fermentum
, the
L. reuteri
subgroup, and the
L. ruminis
subgroup were significantly increased at 4 and 8 weeks after treatment compared with counts before treatment.
Streptococcus
species were also significantly increased at 4 and 8 weeks after PPI treatment compared with counts before treatment (
P
< 0.01 and
P
< 0.001, respectively). There was no significant difference in the total organic acid concentrations before and after PPI treatment. Detection rates of bacteria in blood before and after PPI treatment were 22 and 28%, respectively, with no significant differences.
Conclusions
Our quantitative RT-PCR results showed that gut dysbiosis was caused by PPI use, corroborating previous results obtained by metagenomic analysis.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>29796911</pmid><doi>10.1007/s10620-018-5122-4</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-9671-5585</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0163-2116 |
| ispartof | Digestive diseases and sciences, 2018-11, Vol.63 (11), p.2940-2949 |
| issn | 0163-2116 1573-2568 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6182435 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Aged Bacteria Biochemistry Blood - microbiology Carboxylic Acids - analysis Care and treatment Dysbiosis - chemically induced Feces Feces - chemistry Feces - microbiology Female Gastroenterology Gastroesophageal reflux Gastrointestinal Microbiome - drug effects Health aspects Hepatology High performance liquid chromatography Humans Infection Male Medical colleges Medicine Medicine & Public Health Microbiota Microbiota (Symbiotic organisms) Middle Aged Oncology Original Original Article Proton pump inhibitors Proton Pump Inhibitors - adverse effects Protons RNA Transplant Surgery |
| title | Gut Microbiota Composition Before and After Use of Proton Pump Inhibitors |
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