It is increasingly recognized that PPI use is associated with an elevated risk of infectious diseases. There is growing evidence to explain this association, including decreased gastric acid barrier, altered microbiome and local bacterial overgrowth, altered barrier function of aerodigestive mucosa, attenuation of the immune response, and direct effects on bacteria and decreased effectiveness of antibiotics. PPI-induced hypochloridia is known to alter the gastrointestinal bacterial motif, allowing certain normally absent or depleted pathogenic microorganisms to survive and proliferate
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Superintendent, ICH.