Gastric Bacterial Colonisation in a Swedish Population, with and Without PPI. – Is There a Need for Antibiotic Prophylaxis Prior to Transgastric Notes Procedures?

Per-Ola Park, Professor, Caroline Rydmarker, MD, Anders Lundqvist, MD, PhD, Maria Bergstrom, MD, PhD. Dept of Surgery and Dept of Infectious disease, South Alvsborg Hospital, Boras, Sweden, Gothenburg University, Gothenburg, Sweden.

The aim of this study was to investigate and characterise the gastric bacterial flora in patients with or without PPI treatment. There is a concern about bacterial contamination of the abdominal cavity during transgastric NOTES procedures. Previous studies have shown that the gastric bacterial flora differs from the oral or oesophageal floras. However here are few modern studies on this topic. The common use of PPIs is believed to change gastric bacterial content.

Methods & Procedures
This study was approved by the local IRB-committee. Patients referred for routine gastroscopy, without a history of recent (3 months) or current antibiotic treatment, were eligible for inclusion. Use of PPIs was recorded. At the beginning of the gastroscopy sampling for bacterial culture was performed using a routine ERCP-cytology-brush. Culture analyses were carried out at the hospital laboratory for microbiology. Positive cultures were further analysed for types and subtypes. Gastric biopsies were also taken using ordinary biopsy forceps for CLO-test to detect Helicobacter Pylori.

34 patients were included, 15 of them had ongoing PPI medication. 13 patients had positive bacterial cultures. Significantly more patients with positive cultures had ongoing PPI medication, 9/13, than those without PPI (p= 0.034). The dominating bacterial type was Streptococci of several different subtypes. Hemophilus influenzae and lactobacillus also occurred. This pattern indicates an oral and upper air-way origin. One patient had fungal growth. Only a few patients had positive CLO-test why further comparisons are not possible.

The stomach seems to contain bacteria mainly of oral origin. Therefore patients undergoing transgastric NOTES procedures should receive antibiotic prophylaxis covering the oral bacterial flora. Special attention is needed for patients with ongoing PPI medication.

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