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Peran probiotik dalam menurunkan kejadian smal intestinal bacterial overgrowth pada anak yang mendapat terapi omeprazol jangka panjang = Role of probiotic in reducing the incidence of small intestinal bacterial overgrowth in children receiving treatment with omeprazole

Latar belakang: Omeprazol merupakan obat anti-sekresi asam lambung yang umum digunakan pada anak. Pada beberapa kasus seperti refluks gastroesofagus (RGE) dan tukak lambung/duodenum, terapi omeprazol dibutuhkan dalam jangka panjang. Kejadian SIBO akibat penggunaan omeprazol jangka panjang telah dilaporkan dalam beberapa penelitian pada subyek dewasa, namun penelitian serupa pada subyek anak masih sangat terbatas. Probiotik merupakan mikroorganisme hidup yang bermanfaat bagi flora normal usus. Berbagai penelitian telah menunjukkan manfaat probiotik dalam terapi dan pencegahan diare akut. Sampai saat ini, penelitian mengenai manfaat probiotik dalam mencegah atau mengobati SIBO pada anak yang mendapat terapi omeprazol jangka panjang masih sangat terbatas. Tujuan: Mengetahui insidens SIBO pada anak yang mendapat terapi omeprazol jangka panjang, serta peran pemberian probiotik dalam menurunkan kejadian tersebut. Metode: Uji klinis acak terkontrol tersamar ganda pada 70 subyek dengan keluhan nyeri ulu hati yang dibagi secara acak ke dalam kelompok yang mendapat terapi omeprazol 1x20 mg PO disertai pemberian Lactobacillus rhamnosus R0011 1,9 x 10 9 cfu dan Lactobacillus acidophillus R0052 0,1 x 10 9 cfu, PO (36 subyek), dan kelompok terapi omeprazol disertai plasebo (34 subyek) selama 4 minggu. Hasil: Insidens SIBO ditemukan sebesar 26,5% (9/34). Kejadian SIBO ditemukan lebih tinggi pada kelompok probiotik (33%; 12/36) daripada kelompok plasebo (p=0,13). Simpulan: Insidens SIBO pada anak yang mendapat terapi omeprazol 1x20 mg PO selama 4 minggu adalah 26,5%. Pemberian probiotik tidak menurunkan kejadian SIBO pada anak yang mendapat terapi omeprazol 1x20 mg PO selama 4 minggu (p=0,13).
Kata kunci: omeprazol, small intestinal bacterial overgrowth, probiotik


Background. The major control factor for bacterial survival in the stomach is the acidity of gastric contents. Small intestinal bacterial overgrowth frequently occurs in conditions characterised by diminished gastric acid secretion. Omeprazole as a proton pump inhibitor (PPI) agents is widely used in the treatment of children with gastroesophageal reflux. Despite numerous studies in adults, the extent of SIBO in children during treatment with omeprazole remains unknown due to lack of study. Probiotics are supplements or foods that contain viable microorganisms that cause alterations of the microflora of the host. Use of probiotics has been shown to be modestly effective in randomized clinical trials (RCTs) in treating acute viral gastroenteritis and preventing antibiotic-associated diarrhea in healthy children. The role of probiotics in reducing the incidence of SIBO in children under treatment with omeprazole has not been reported yet. Objective. To know the incidence of SIBO in children under treatment of omeprazole and the role of probiotics in reducing the incidence. Method. Double-blind, placebo-controlled clinical trial in 70 subjects during 4 weeks treatment of 1x20 mg omeprazole, orally. Lactobacillus rhamnosus R0011 (1,9 x 10 9 cfu) and Lactobacillus acidophillus R0052 (0,1 x 10 9 cfu) daily was given simultaneously to 36 subjects (probiotic group), while the other 34 subjects received placebo (placebo group). Further intention was diagnosing SIBO by clinical findings and hydrogen breath test (HBT). Result. Subjects in probiotics group showed higher incidence of SIBO (12/36; 33%) compared to subjects in placebo group (9/34; 26,5%). The different incidence between groups was statistically unsignificant (p=0.13). Conclusion. Incidence of SIBO in children under 4 weeks treatment of 1x20 mg omeprazole orally was 26,5%. Probiotic was not proven reducing the incidence of SIBO in children under 4 weeks treatment of 1x20 mg omeprazole.
Keywords. Small intestinal bacterial overgrowth, probiotic, omeprazole