Long-Term PPIs, Role of Probiotics for Gut & Metabolic Health - Dr Banshi Saboo

Dr Banshi Saboo, one of the renowned Diabetologists, presented his valuable opinion on IPROCON the first-ever Indian probiotic consensus at the European Association for the Study of Diabetes (EASD) conference, 2023, held in Germany. He shared his views about the long term Proton Pump Inhibitors (PPIs) use and role of probiotics for Gut and Metabolic health.

Below are the key highlights from the interview:

Q) What is your opinion on the prescription of Proton Pump Inhibitors (PPIs) with OADs?

With an increase in prescriptions for Metformin and Voglibose, many doctors co-prescribe PPIs for every diabetic patient. Therefore, it is very common to prescribe PPIs for individuals with diabetes.

Q) What is your opinion on the rational use of Proton Pump Inhibitors (PPIs)?

The prophylactic use of PPIs is highly prevalent, often in response to complaints such as gastric fullness. Additionally, diabetic patients may experience autonomic dysfunction of the stomach, contributing to symptoms related to GERD. Hence, prescriptions for PPIs serve both; as a response for symptomatic relief and, at the same time, are written in high frequency for prophylactic purposes.

Q) What is the Potential Impact of Proton Pump Inhibitors (PPIs) on gut microbiota?

Now, this has been a longstanding question regarding the long-term prescription of PPIs. We all know that gut microbiota is very important for metabolic homeostasis, not only glucose homeostasis. Prescribing PPIs for a long time can disturb the gut microbiota and may be responsible for increasing metabolic problems.

Q) What are the potential benefits of Co-Prescribing probiotics with Proton Pump Inhibitors (PPIs) and their role in the improvement of Quality of Life (QoL)?

The use of probiotics in our country is relatively less. They are used only when someone develops diarrhea, antibiotic-associated diarrhea (AAD); but now we are seeing more uses of probiotics among our pediatrician colleagues for pediatric patients. However, I fully agree that there should be more use of prebiotics and probiotics in diabetic patients; it will definitely help our patients. There has been a lot of data generated in the last decade regarding the uses of pre-and probiotics in diabetic patients. With the uses of pre and probiotics, particularly for patients on a long-term PPI prescription, they should be given probiotics to improve their metabolic health and GI system.