AUTHOR=Ouyang Meng-Ling , Zou Shu-Peng , Cheng Qian , Shi Xuan , Zhao Ya-Zheng , Sun Ming-Hui 

TITLE=Effect of potassium-competitive acid blockers on human gut microbiota: a systematic review and meta-analysis

JOURNAL=Frontiers in Pharmacology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1269125

DOI=10.3389/fphar.2023.1269125

ISSN=1663-9812

ABSTRACT=<p><bold>Background:</bold> Vonoprazan has been reported to exert more potent and long-lasting gastric acid inhibition than proton pump inhibitors, potentially leading to a greater impact on the gut microbiota. This study aimed to clarify changes in microbial diversity and bacterial composition after VPZ treatments.</p><p><bold>Methods:</bold> We searched from PubMed, Embase, WOS, Scopus, Cochrane Library, and <italic>ClinicalTrials.gov</italic> (all years up to May 2023). The primary outcomes were alpha and beta diversity, as well as differences in gut microbiota composition between before and after VPZ treatments. We performed a meta-analysis to uncover the potential changes in human gut microbiota among VPZ users by pooled mean difference (MD) with a 95% confidence interval (CI). The risk of bias was assessed using the ROBINS-I tool.</p><p><bold>Results:</bold> A total of 12 studies were included to compare differences before and after VPZ treatments. Compared with baseline, alpha diversity was significantly reduced after VPZ treatments and gradually returned to baseline with longer follow-up. At the phylum level, there was a decrease in the relative abundance of <italic>Firmicutes</italic> and <italic>Actinobacteria</italic>, while <italic>Bacteroidetes</italic> increased compared with baseline. At the genus level, we found a significant decrease in the relative abundance of <italic>Coprococcus</italic> and <italic>Bifidobacterium</italic> and a significant increase in the relative abundance of <italic>Bacteroides</italic> compared with those before treatment. In subgroup analyses according to country and participants, we found differences in microbial changes after VPZ treatments.</p><p><bold>Conclusion:</bold> Vonoprazan can affect the changes of gut microbiota, which may be potentially associated with its strong ability of acid inhibition. However, due to the large heterogeneity, further studies are required to validate these findings.</p><p><bold>Systematic Review Registration:</bold><ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/prospero/</ext-link>, identifier CRD42023412265.</p>