Are proton-pump inhibitors indicated for treating intestinal Candida overgrowth or acute gastroenteritis?

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Last updated: February 27, 2026 • View editorial policy

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PPIs Are NOT Used to Treat Intestinal Candida or Acute Gastroenteritis

Proton pump inhibitors (PPIs) are not indicated for treating intestinal Candida overgrowth or acute gastroenteritis; in fact, PPIs are a recognized risk factor for both conditions and should be discontinued when no valid indication exists. 1

PPIs as a Risk Factor for Gastroenteritis and Candidiasis

Evidence of Increased Infection Risk

  • PPIs significantly increase the risk of gastroenteritis by suppressing gastric acid, which normally serves as a protective barrier against enteric pathogens. Evidence demonstrates that acid suppression with PPIs is a risk factor for community-acquired gastroenteritis. 1

  • PPIs increase the risk of candidemia and Candida colonization throughout the gastrointestinal tract. Research shows that omeprazole and pantoprazole increase the risk of gastric candidiasis by 12.99 and 9.20 times, respectively. 2

  • The mechanism involves disruption of the gastric acid barrier and alteration of the gut microbiome, creating an environment permissive for pathogenic overgrowth. PPIs cause polymicrobial small bowel bacterial overgrowth and alter the normal bacterial milieu throughout the GI tract. 3

Additional Infection Risks

  • PPIs are associated with increased risk of Clostridium difficile infection (CDI), with continuous PPI use conferring a 1.5-fold increased risk of CDI recurrence (95% CI, 1.1-2.0). 4

  • PPIs increase susceptibility to necrotizing enterocolitis in preterm infants, making their use particularly concerning in vulnerable populations. 1

Clinical Management: When to Discontinue PPIs

Stewardship Principles

  • Discontinue PPIs immediately when no evidence-based indication exists, particularly in patients who develop gastroenteritis or Candida infections. Although no RCT has studied discontinuation specifically for CDI risk, stewardship activities to stop unneeded PPIs are strongly warranted. 1

  • Only 47.1% of patients taking PPIs have an evidence-based indication, yet PPIs are discontinued in only a small minority of patients even after developing complications like CDI. 4

Valid Indications for PPI Use

PPIs should only be continued for clear evidence-based indications, including:

  • Gastroesophageal reflux disease (GERD) with documented esophagitis 1
  • Prevention of esophageal ulcers and strictures in systemic sclerosis 1
  • Upper GI bleeding following endoscopic therapy (high-dose IV bolus followed by continuous infusion) 1
  • Gastroprotection in patients on steroids with risk factors (age ≥65, previous GI events, concurrent NSAIDs/anticoagulants) 5
  • Upper GI Crohn's disease without stenosis (as first-line therapy) 6

Specific Contraindications and Cautions

Ulcerative Colitis and Microscopic Colitis

  • In ulcerative colitis, avoid unnecessary PPIs and prescribe only for clear indications at the lowest effective dose, as PPIs may worsen disease activity. 6

  • PPIs are a potential trigger for microscopic colitis; clinicians should evaluate the necessity of ongoing PPI therapy and discontinue when no compelling indication exists. 6

Monitoring Considerations

  • PPIs independently raise fecal calprotectin levels through microbiome alterations, requiring a 3-week PPI wash-out before using calprotectin to assess inflammatory bowel disease activity. 6

Common Pitfalls to Avoid

  • Do not prescribe PPIs prophylactically for patients at risk of gastroenteritis or Candida infections—this represents a fundamental misunderstanding of PPI pharmacology and will worsen outcomes.

  • Do not continue PPIs "just in case" after an acute illness resolves; systematic review of PPI prescriptions should occur, particularly in patients who develop infectious complications. 6, 4

  • Recognize that 60.7% of patients with CDI are taking PPIs, with the majority lacking valid indications—this represents a major opportunity for de-prescribing. 4

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Guideline

PPI Regimen for Patients on Steroid Therapy

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

6
Guideline

Proton Pump Inhibitor Use in Colitis – Guideline Summary

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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