Changes in gastric mucosa and luminal environment during acid-suppressive therapy: A review in depth

Acid-suppressive therapy and subsequent changes in gastric mucosa and lumin al environment rank highly amongst the investigated issues in gastroenterol ogy over the past two to three decades. Herewith, we present an overview of these intragastric changes, particularly during long-term administration o f acid-suppresive medication and concurrent infection with Helicobacter pyl ori. Current evidence indicates that: il Long-term acid suppression facilit ates the development of fundic ECL cell hyperplasia, especially in the pres ence of Helicobacter pylori. No neoplastic changes directly attributable to acid suppression have so far been demonstrated in humans. ii] Acid-suppres sive therapy increases the risk of enteric infections. iii) Acid-suppressiv e therapy does not alter fat and mineral bioavailability but may decrease t he absorption of protein-bound vitamin B-18. iv) Acid suppression invariabl y results in intragastric overgrowth of non-Helicobacter pylori bacterial s pecies. The concurrent infection with Helicobacter pylori may promote this bacterial overgrowth and the intragastric formation of N-nitrosamines. v] A cid-suppressive therapy alters the natural course of Helicobacter pylori ga stritis, transforming the antral-predominant pattern into a body-predominan t pattern, which in turn may progress to body gland atrophy. The pathophysi ology of this phenomenon is currently under investigation. vi) In view of t he potential adverse effects of acid suppression in the presence of Helicob acter pylori, the screen-and-treat strategy is advocated for Helicobacter p ylori in subjects considered for long-term treatment.