Alteration in digestion and absorption of nutrients during profound acid suppression

Gastric acid suppression therapy has for many years been the cornerstone of the treatment of peptic disease. The availability of more potent inhibitor s of gastric acid secretion and the increasing demand for maintenance thera py has renewed interest in the potential side-effects of profound and/or lo ng-lasting therapy. This chapter focuses on the potential interference of g astric acid suppression therapy with the process of the digestion and absor ption of nutrients. The theoretical mechanisms by which hypochlorhydria res ulting from gastric acid suppression therapy may hamper digestion and absor ption are multiple and well documented. Clinical studies evaluating the eff ect of gastric acid suppression therapy on the assimilation of nutrients ar e, on the other hand, scarce and have, moreover, yielded conflicting result s. The reason for the latter may be related, at least in part, to elements of study design, Data indicating overt malabsorption or clear deficiencies in patients on long-term gastric acid suppression therapy are currently lac king, Nevertheless, it seems prudent, while awaiting the results of additio nal long-term studies, regularly to monitor these patients, especially thos e with increased nutrient demand, poor intake or suboptimal stores.