Effect of acid-suppressive drugs on endoscopic transmural drainage of peripancreatic fluid collections - A randomized controlled trial

Abstract Background Acid-suppressing drugs affect intestinal microbes by inhibiting the secretion of stomach acid. However, it is not clear whether acid suppressive drugs affect the microorganisms in the peripancreatic effusion and affect the postoperative complications. Methods This study was a prospective randomized controlled trial. A total of 45 patients were enrolled in the trial, and all patients were divided into acid-inhibited and non-inhibited groups. The primary endpoint of our study was to observe the difference of microbiota in the two groups of cyst fluid. Results A total of 25 patients were included in the acid-inhibited group and 20 patients were included in the non-acid-inhibited group. There were no significant differences between the two groups in terms of postoperative infection, bleeding, and recurrence rates (p > 0.05). In terms of postoperative C-reactive protein levels, the acid-suppressing group was significantly higher than the non-acid-suppressing group (p < 0.05). In the 16S microbial sequencing analysis, we found no significant difference in α diversity between the antibiotic group and the non-antibiotic group, but there was a statistically significant difference in β diversity between the two groups Conclusion Acid-suppressing drugs can change the microbial composition of pancreatic effusions and increase markers of postoperative inflammation. Acid-suppressive drugs may increase the potential infection after endoscopic drainage.