Rational use of PPIs and consideration of Probiotics ft Dr V Mohan

Dr. V. Mohan, an Indian Diabetologist, presented his valuable opinion on IPROCON the first-ever Indian probiotic consensus at European Association for the Study of Diabetes (EASD) conference, 2023, held in Germany. He delved into essential topics related to rational use of Proton Pump Inhibitors (PPIs) and the potential advantages of co-prescribing probiotics along with PPI to enhance gut health.

Here are the major excerpts from the interview:

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

It's quite common to prescribe the PPIs in our practice because a lot of Indians come with GERD symptoms, gastritis symptoms, heartburn and all that- because of the spicy food that they take leading to indigestion and so on. Hence, it's quite commonly used.

Q) What is your opinion on Rational Use of Proton Pump Inhibitors (PPIs)?

It should be more scientifically prescribed because we know that indiscriminate use of PPIs will lead to tolerance and the drug will not work anymore. Then you have to use higher doses or change it, and therefore, I think strict guidelines have to be prepared for the use of these (PPIs).

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

There are reports coming that indiscriminately if you use these PPIs, they can alter the gut microbiota so instead of having healthy gut microbes you can have very unhealthy gut microbes which can lead to series of metabolic disturbances including a leaky gut which leads to inflammation, obesity, type 2 diabetes, heart disease and even some forms of cancer. As they say so it's very important to preserve the gut microbes.

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

Yes, I think so. I think although we need to do more studies in the Indian context but it makes sense that if the gut microbiota is going to be altered by any particular group of drugs, then giving a Prebiotic or a probiotic definitely makes sense. This is common because if you take antibiotics whenever you use an antibiotic, we know that you get diarrhoea why do you get that because the gut microbes are being altered. So, nowadays its common practice that whenever an antibiotic is given to give a probiotic along with that. Similarly, I think whichever groups of drugs are known to affect the gut microbiota prescribing a Prebiotic or a probiotic along with that makes absolute sense.