Effects of very long (up to 10 years) proton pump blockade on human gastric mucosa

被引:58
作者
Lamberts, R
Brunner, G
Solcia, E
机构
[1] Univ Tubingen, Dept Internal Med, Div Gastroenterol, D-72076 Tubingen, Germany
[2] Hannover Med Sch, Div Gastroenterol & Hepatol, Dept Med, D-3000 Hannover, Germany
[3] Univ Pavia, Dept Human Pathol, I-27100 Pavia, Italy
[4] IRCCS Policlin S Matteo, Pavia, Italy
关键词
gastroesophageal reflux disease; peptic ulcer; proton pump inhibitor therapy; gastritis; atrophy; Helicobacter pylori; hypergastrinemia;
D O I
10.1159/000048863
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background. Long-term use of proton pump inhibitors (PPI) has been reported to worsen oxyntic mucosa gastritis and the resulting gland atrophy has been considered a potential risk factor for neoplastic changes in the gastric mucosa. Aims:The present study examines the effect of extended continuous PPI treatment for up to 10 years on the exocrine and endocrine stomach of patients with acid-related diseases of the upper GI tract. Methods: Biopsies from the antral and oxyntic mucosa taken at regular time intervals were examined for gastritis, atrophy, intestinal metaplasia, Helicobacter pylori and argyrophil cells and correlated to serum gastrin levels. Results: A general amelioration of antral gastritis without relevant changes of atrophy or intestinal metaplasia, contrasted with the worsening of gastritis and gland atrophy seen in the oxyntic mucosa of reflux esophagitis (but not gastric or duodenal ulcer) patients in the presence of H. pylori infection. In association with PPI-induced hypergastrinemia, argyrophil cell hyperplasia (but not dysplasia or neoplasia) developed in the oxyntic mucosa. Conclusion: The present results outline the milder pretreatment pattern and higher proneness to PPI-related, H. pylori-restricted worsening of oxyntic mucosa gastritis in reflux esophagitis compared to gastric ulcer or duodenal ulcer patients. In addition, they confirm a substantial safety of long-term PPI therapy as concerns neoplastic changes in the exocrine and endocrine human stomach.
引用
收藏
页码:205 / 213
页数:9
相关论文
共 51 条
[1]   Helicobacter pylori gastritis and epithelial cell proliferation in patients with reflux oesophagitis after treatment with lansoprazole [J].
Berstad, AE ;
Hatlebakk, JG ;
Maartmann-Moe, H ;
Berstad, A ;
Brandtzaeg, P .
GUT, 1997, 41 (06) :740-747
[2]   GASTRIC ENDOCRINE CELL HYPERPLASIA AND CARCINOID-TUMORS IN PERNICIOUS-ANEMIA [J].
BORCH, K ;
RENVALL, H ;
LIEDBERG, G .
GASTROENTEROLOGY, 1985, 88 (03) :638-648
[3]   GASTRIC ENDOCRINE CELL-PROLIFERATION AND FUNDIC ARGYROPHIL CARCINOID-TUMORS IN PATIENTS WITH THE ZOLLINGER-ELLISON SYNDROME [J].
CADIOT, G ;
LEHY, T ;
MIGNON, M .
ACTA ONCOLOGICA, 1993, 32 (02) :135-140
[4]   THE SYNDROME OF GASTRIC ARGYROPHIL CARCINOID-TUMORS AND NONANTRAL GASTRIC ATROPHY [J].
CARNEY, JA ;
GO, VLW ;
FAIRBANKS, VF ;
MOORE, SB ;
ALPORT, EC ;
NORA, FE .
ANNALS OF INTERNAL MEDICINE, 1983, 99 (06) :761-766
[5]  
CORREA P, 1970, J NATL CANCER I, V44, P297
[6]  
CORREA P, 1975, LANCET, V2, P58
[7]  
CORREA P, 1990, CANCER RES, V50, P4737
[8]   MUCOSAL IGA RECOGNITION OF HELICOBACTER-PYLORI 120-KDA PROTEIN, PEPTIC-ULCERATION, AND GASTRIC PATHOLOGY [J].
CRABTREE, JE ;
TAYLOR, JD ;
WYATT, JI ;
HEATLEY, RV ;
SHALLCROSS, TM ;
TOMPKINS, DS ;
RATHBONE, BJ .
LANCET, 1991, 338 (8763) :332-335
[9]  
CREUTZFELDT W, 1999, PROTON PUMP INHIBITO, P91
[10]   OMEPRAZOLE V RANITIDINE FOR PREVENTION OF RELAPSE IN REFLUX ESOPHAGITIS - A CONTROLLED DOUBLE-BLIND TRIAL OF THEIR EFFICACY AND SAFETY [J].
DENT, J ;
YEOMANS, ND ;
MACKINNON, M ;
REED, W ;
NARIELVALA, FM ;
HETZEL, DJ ;
SOLCIA, E ;
SHEARMAN, DJC .
GUT, 1994, 35 (05) :590-598