Effect of long-term, continuous versus alternate-day omeprazole therapy onserum gastrin in patients treated for reflux esophagitis

Background: Proton pump inhibitors have been proven to have a major role in the management of peptic diseases, especially the long-term control of ref lux esophagitis. The potent inhibitory effect of omeprazole on gastric acid secretion is frequently associated with hypergastrinemia,and gastrin and i ts intermediates have been reported to promote gastrointestinal cellular fu nctions and cell growth. Experimental data suggest that gastrin may affect the proliferation of colon cells and some other cancer cells. However, so f ar the direct role of gastrin in tumorigenesis is unclear. Although most cl inical studies on long-term treatment with omeprazole or other proton pump inhibitors do not report serious adverse effects,the issue of prolonged hyp ergastrinemia and tissue growth is unsettled, and many clinicians are reluc tant to recommend long term use of omeprazole or of other proton pump inhib itors. Study: We examined the effect of long-term omeprazole treatment on s erum gastrin levels in patients with reflux esophagitis when given either 2 0 mg daily (group 1) or on alternate days (group 2). During the follow-up p eriod, clinical remission was monitored and maintained in all patients in g roup 1 and in the majority of patients in group 2. Results: The mean serum gastrin level was significantly elevated in group 1 (mean +/- SE, 159 +/- 2 3.6 pg/mL; range, 45-620 pg/mL; n = 31) as compared with the alternate-day treatment group (group 2) (66 +/- 4.8 pg/mL; range, 37-115 pg/mL; n = 21) ( p < 0.005). In controls, serum gastrin levels showed similar Values to thos e found in group 2 (54 +/- 4.3 pg/mL; range, 27-94 pg/mL; n = 20). Fourteen patients (45%) in group 1 had serum gastric ranging from 140 to 620 pg/mL, and 8 (25%) had a 6-fold or greater increase in serum gastrin. The follow- up treatment period ranged between 3 and 60 months (mean +/- SE, 16.1 +/- 2 .1 months) for group 1 and 3-36 months (9.7 +/- 1.4 months) for group 2. Up on multivariate adjustment for age and duration of treatment, a significant ly lower mean serum gastrin level was observed in the alternate-day group a s compared with the daily treated group. Conclusion: Alternate-day, long-te rm treatment with omeprazole may be adequate to maintain remission in patie nts with reflux esophagitis. This regimen can assure serum gastrin levels w ithin the normal range, thus reducing the potential risk of prolonged, sust ained hypergastrinemia and profound hypochlorhydria.