Long-term acid control and proton pump inhibitors: interactions and safety issues in perspective.

Concerns have been raised regarding the safety of proton pump inhibitors in the long-term management of acid-related peptic disease, especially with regard to the physiological effects of prolonged hypochlorhydria. Of special consideration is the potential for development of enterochromaffin-like cell hyperplasia and gastric carcinoids, colorectal adenocarcinoma and polyps, and bacterial overgrowth as a result of achlorhydria. However, the magnitude of hypergastrinemia associated with the administration of proton pump inhibitors is comparable to that observed after vagotomy and is 3- to 6-fold lower than that observed with pernicious anemia. Only minimal morphological changes in gastric endocrine cells have been observed after the long-term daily administration of proton pump inhibitors, and these changes appear to be self-limiting, nondysplastic, and nonneoplastic. All current evidence suggests that the hypergastrinemia observed during proton pump inhibitor therapy has little clinical significance. However, longer-term results are necessary so that one can appreciate the full implications of acid suppression by proton pump inhibitors.
AuthorsJ W Freston
JournalThe American journal of gastroenterology (Am J Gastroenterol) Vol. 92 Issue 4 Suppl Pg. 51S-55S; discussion 55S-57S (Apr 1997) ISSN: 0002-9270 [Print] UNITED STATES
PMID9127627 (Publication Type: Journal Article, Review)
Chemical References
  • Antacids
  • Anti-Ulcer Agents
  • Gastrins
  • Histamine H2 Antagonists
  • Proton Pump Inhibitors
  • Antacids (adverse effects, therapeutic use)
  • Anti-Ulcer Agents (therapeutic use)
  • Drug Interactions
  • Gastrins (blood)
  • Histamine H2 Antagonists (therapeutic use)
  • Humans
  • Peptic Ulcer (blood, drug therapy, microbiology)
  • Proton Pump Inhibitors
  • Safety
  • Time Factors

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