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.
Freston
J W
JW
Department of Medicine, University of Connecticut School of Medicine, Farmington 06030, USA.
D000863:Antacids / Q000009:adverse effects / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D004347:Drug Interactions; D005755:Gastrins / Q000097:blood; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D010437:Peptic Ulcer / Q000097:blood / Q000188:drug therapy / Q000382:microbiology; D054328:Proton Pump Inhibitors; D012449:Safety; D013997:Time Factors
D000863:Antacids; D000897:Anti-Ulcer Agents; D005755:Gastrins; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors