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However, certain periodontal pathogens, including Porphyromonas gingivalis , Klebsiella , Helicobacter pylori , Streptococcus , Veillonella , Parvimonas micra , and Fusobacterium nucleatum can endure harsh acidic environments and migrate to the intestine 24 , particularly in individuals with reduced gastric acid levels, such as those using proton pump inhibitors (PPIs) 25

If you truly feel nothing at 0.25 mg after a full four weeks, that is normal

By asking patients about all sources of care, providers can identify potential gaps early