| Review article: potential gastrointestinal effects of long-term acid suppression with proton pump inhibitors. | |
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MedLine Citation:
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PMID: 10848649 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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This review examines the evidence for the development of adverse effects due to prolonged gastric acid suppression with proton pump inhibitors. Potential areas of concern regarding long-term proton pump inhibitor use have included: carcinoid formation; development of gastric adenocarcinoma (especially in patients with Helicobacter pylori infection); bacterial overgrowth; enteric infections; and malabsorption of fat, minerals, and vitamins. Prolonged proton pump inhibitor use may lead to enterochromaffin-like cell hyperplasia, but has not been demonstrated to increase the risk of carcinoid formation. Long-term proton pump inhibitor treatment has not been documented to hasten the development or the progression of atrophic gastritis to intestinal metaplasia and gastric cancer, although long-term studies are required to allow definitive conclusions. At present, we do not recommend that patients be tested routinely for H. pylori infection when using proton pump inhibitors for prolonged periods. Gastric bacterial overgrowth does increase with acid suppression, but important clinical sequelae, such a higher rate of gastric adenocarcinoma, have not been seen. The risk of enteric infection may increase with acid suppression, although this does not seem to be a common clinical problem with prolonged proton pump inhibitor use. The absorption of fats and minerals does not appear to be significantly impaired with chronic acid suppression. However, vitamin B12 concentration may be decreased when gastric acid is markedly suppressed for prolonged periods (e.g. Zolllinger-Ellison syndrome), and vitamin B12 levels should probably be assessed in patients taking high-dose proton pump inhibitors for many years. Thus, current evidence suggests that prolonged gastric acid suppression with proton pump inhibitors rarely, if ever, produces adverse events. Nevertheless, continued follow-up of patients taking proton pump inhibitors for extended periods will provide greater experience regarding the potential gastrointestinal adverse effects of long-term acid suppression. |
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Authors:
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L Laine; D Ahnen; C McClain; E Solcia; J H Walsh |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Alimentary pharmacology & therapeutics Volume: 14 ISSN: 0269-2813 ISO Abbreviation: Aliment. Pharmacol. Ther. Publication Date: 2000 Jun |
Date Detail:
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Created Date: 2000-08-01 Completed Date: 2000-08-01 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8707234 Medline TA: Aliment Pharmacol Ther Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 651-68 Citation Subset: IM |
Affiliation:
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University of Southern California School of Medicine, Los Angeles, California 90033, USA. llaine@usc.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adenocarcinoma
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chemically induced* Anti-Ulcer Agents / administration & dosage, adverse effects* Carcinoid Tumor / chemically induced* Gastric Acid / metabolism* Helicobacter Infections / complications Humans Malabsorption Syndromes / chemically induced Proton Pumps / antagonists & inhibitors* Risk Factors Stomach Diseases / chemically induced Stomach Neoplasms / chemically induced* Stomach Ulcer / drug therapy |
| Chemical | |
Reg. No./Substance:
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0/Anti-Ulcer Agents; 0/Proton Pumps |
| Comments/Corrections | |
Comment In:
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Aliment Pharmacol Ther. 2001 May;15(5):729-30
[PMID:
11328270
]
Aliment Pharmacol Ther. 2000 Nov;14(11):1537-8 [PMID: 11069327 ] Aliment Pharmacol Ther. 2001 Jul;15(7):1085-6 [PMID: 11421886 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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