Proton pump inhibitors (PPIs) are some of the most commonly prescribed drugs worldwide, but there are increasing concerns about digestive complications linked to PPIs. Next-generation sequencing studies have suggested that PPIs can significantly affect the composition of the gut microbiota, which in turn may substantially contribute to the development of these complications. Recently, emerging evidence has suggested that the translocation of oral microbes into the gut may be the primary mechanism underlying the alterations in the gut microbiota induced by PPIs in the presence of gastric acid suppression and impaired oral–gut barrier function. Moreover, the significance of oral–gut microbial translocation in health and disease conditions has gained increasing recognition. Consequently, it is imperative to enhance our understanding of the functions of the oral–gut microbiota axis in digestive disorders associated with PPI therapies. This review aims to summarize current research findings and further elucidate the contribution of the oral–gut microbiota to the pathogenesis of PPI-related digestive diseases. We aim to provide a theoretical foundation for future therapeutic and preventive strategies targeting PPI-related digestive complications through modulation of the oral–gut microbiota.

Background and Aims: Transcatheter arterial embolization (TAE) is recommended for refractory peptic ulcer bleeding. There are 46% of patients showed no detectable contrast extravasation during TAE. Endoscopic clip in bleeding lesion is visible and could be used as a marker in TAE. We aimed to learn whether endoscopic clips marking would ameliorate the prognosis. Methods: We retrospectively collected data of patents who received TAE because of refractory peptic ulcer bleeding, between 1 January 2016 to 31 December 2022. 188 patients were included and divided into two groups according to clips visibility in angiography. Baseline data about age, gender, bleeding severity, comorbidities, history of antiplatelet or anticoagulation drugs and endoscopic findings were balanced with the inverse probability of treatment weighting method. Results: There were 59 patients without clips received TAE, and 129 with clips. The in-hospital rebleeding rate after TAE was much higher in patients without clip than with clips (45.8% vs 33.3%). Cox regression analysis indicated that endoscopic clips marking decreased the rebleeding (aHR=0.492, 95%CI: 0.242-1.001, p=0.050). Also, in patient with clips, the empirical TAE rate was higher (64.3% vs 11.9%, p<0.001). No difference in in-hospital all-cause mortality was found (without clips vs with clips 11.9% vs 12.4%). The hospital stay length and embolized vessels types showed no differences between the two groups. Conclusions: In refractory peptic ulcer bleeding patients, endoscopic clips marking decreased the in-hospital rebleeding rate after TAE, but did not affect the mortality.

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