THE USE OF GASTRIC ACID-INHIBITORY DRUGS - PHYSIOLOGICAL AND PATHOPHYSIOLOGICAL CONSIDERATIONS

All vertebrates secrete gastric acid. Acid denatures the proteins in t he food and thus makes them more accessible to proteolytic enzymes, an d it kills swallowed micro-organisms. Gastric acid plays an important pathogenetic role in peptic ulcer disease and reflux oesophagitis. In these diseases, drugs that inhibit secretion of gastric acid will heal the lesions and suppress the symptoms. However, both reflux oesophagi tis and peptic ulcer tend to recur when the acid-inhibitory treatment is stopped. Therefore, these patients often require long-term treatmen t with acid-inhibitors. In this overview the potential risks of long-t erm profound inhibition of acid secretion, raising the pH above 4 for a considerable time, resulting in reduced killing of micro-organisms a nd secondary hypergastrinaemia, are discussed. Gastrin regulates both the function (production and release of histamine) and growth of the e nterochromaffin-like (ECL) cell. Hitherto, the role that this cell pla ys in gastric carcinogenesis appears to have been underestimated.