Steves et al. performed 16S ribosomal RNA amplification on faecal samples from 1,827 twins to investigate the association between PPI use and composition of the gut microbiota. A lower abundance in gut commensals and reduced microbial diversity were identified in PPI users compared with non-users, along with an increase in the abundance of oral and upper gastrointestinal tract commensals. These findings were replicated in an independent interventional study. The authors conclude by cautioning against the overuse of PPIs and suggest that further study is needed in this area.