PPIs Are NOT Used to Treat Intestinal Parasitic Infections
Proton pump inhibitors have no therapeutic role in treating parasitic infections; in fact, they increase susceptibility to enteric infections, including parasitism, by eliminating the protective gastric acid barrier. 1, 2
Why PPIs Increase Infection Risk Rather Than Treat It
Mechanism of Increased Infection Susceptibility
PPIs suppress gastric acid production, which normally serves as the first-line defense against ingested pathogens, including parasites, bacteria, and other enteric organisms. 2, 3
By raising gastric pH above 4, PPIs allow viable parasites and other pathogens to survive passage through the stomach and colonize the small intestine. 4, 5
PPI-induced dysbiosis creates an environment that favors pathogen overgrowth—studies demonstrate increased oral and upper GI tract bacteria in the lower gut, along with reduced microbial diversity and depletion of protective commensals. 3, 5
Documented Infectious Complications
Observational and randomized trial data confirm that PPIs are associated with increased risks of enteric infections, including Clostridioides difficile, small intestinal bacterial overgrowth (SIBO), and other intestinal pathogens. 1, 4
The microbiota changes induced by PPIs decrease defense against enteric infections through loss of colonization resistance and impaired mucosal barrier function. 1, 2
Legitimate Indications for PPI Use (None Related to Parasites)
Absolute Indications
Peptic ulcer disease, chronic NSAID use requiring gastroprotection, Helicobacter pylori eradication therapy, and erosive esophagitis (Los Angeles grade C/D) are the only absolute indications for long-term PPI therapy. 1, 6
Barrett's esophagus, eosinophilic esophagitis, and Zollinger-Ellison syndrome require ongoing PPI therapy and should not be considered for de-prescribing. 1, 7
Gastroprotection in High-Risk Patients
- PPIs reduce upper GI bleeding risk by 50% in patients on antiplatelet therapy, with specific indications including history of upper GI bleeding, multiple antithrombotics, or aspirin/NSAIDs with additional risk factors. 7
Critical Clinical Pitfall
Up to 70% of chronic PPI prescriptions are potentially inappropriate—many patients receive PPIs without clear indication, exposing them to infection risk without therapeutic benefit. 7
Regular review of ongoing indications for PPI use is mandatory; discontinuation should be pursued when no valid indication exists. 1, 7
Management of Parasitic Infections in PPI Users
If a patient on chronic PPI therapy develops a parasitic infection, the PPI should be discontinued if clinically feasible to restore gastric acid barrier function and reduce reinfection risk. 2, 4
Antiparasitic therapy (e.g., metronidazole for Giardia, albendazole for helminths) is the appropriate treatment—PPIs play no therapeutic role and should be avoided unless a separate, valid acid-related indication exists. 6, 4