Gastric mucosal morphological consequences of acid suppression: a balanced view

• Published in: Baillière's best practice & research. Clinical gastroenterology Vol. 15; no. 3; pp. 497 - 510
• Main Authors: Meuwissen, S.G.M., Craanen, M.E., Kuipers, E.J.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.06.2001
• Subjects: Anti-Ulcer Agents - therapeutic use; atrophic gastritis; gastric antrum; gastric corpus; gastric mucosa; Gastric Mucosa - drug effects; Gastritis - chemically induced; Gastritis - drug therapy; gastro-oesophageal reflux disease; Helicobacter Infections - drug therapy; Helicobacter pylori; Helicobacter pylori - drug effects; Humans; omeprazole; proton pump inhibitor; Proton Pump Inhibitors; Time; Treatment Outcome; gastric mucosa; omeprazole; Helicobacter pylori; gastric corpus; atrophic gastritis; proton pump inhibitor; gastric antrum; gastro-oesophageal reflux disease
• ISSN: 1521-6918; 1532-1916
• DOI: 10.1053/bega.2001.0189

In the chapter, an analysis of the literature on the relationship between Helicobacter pylori, the use of proton pump inhibitors and the development of atrophic gastritis is presented, and the difficulties of classifying gastritis and the new possibilities of quantifying chronic inflammation by morphometric analysis are discussed. The issue surrounding the necessity of eradicating H. pylori in H. pylori -positive patients has still not been solved. Most studies have now accepted that proton pump inhibitors indeed accelerate the onset of atrophic gastritis in H. pylori -positive patients, but evidence against such an association was published in one recent (Scandinavian) study; conclusions from this study have, however, been challenged by several groups. Some data are available on the efficacy of H. pylori eradication with regard to the prevention of atrophy. The limited significance of the development of parietal cell protrusions and fundic gland cysts is better understood, but much less is known of the development and long-term consequence ofH. pylori -induced autoimmune gastritis. Finally, recent studies in H. pylori -positive patients indicate that treatment with proton pump inhibitors may promote bacterial N -nitrosation formation. These data taken together suggest that the eradication of H. pylori may be based not only on morphological arguments, but also on bacterial alterations in the gastric milieu.