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CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2013; 04(01): 001-005
DOI: 10.1055/s-0039-1700260
Original Article
Society of Gastrointestinal Endoscopy of India

Effects of long-term acid suppressants with ranitidine and omeprazole on gastric mucosa

Alexander P C.
Department of Gastroenterology and Pathology, Stanley Medical College Hospital, and Global Health City, Chennai
,
Ramya S.
Department of Gastroenterology and Pathology, Stanley Medical College Hospital, and Global Health City, Chennai
,
Rajkumar Soloman T.
Department of Gastroenterology and Pathology, Stanley Medical College Hospital, and Global Health City, Chennai
,
Raja S.
Department of Gastroenterology and Pathology, Stanley Medical College Hospital, and Global Health City, Chennai
,
Priyadarshini M.
Department of Gastroenterology and Pathology, Stanley Medical College Hospital, and Global Health City, Chennai
,
Geetha R.
Department of Gastroenterology and Pathology, Stanley Medical College Hospital, and Global Health City, Chennai
,
Vijaya Srinivasan
Department of Gastroenterology and Pathology, Stanley Medical College Hospital, and Global Health City, Chennai
,
Jayanthi V.
Department of Gastroenterology and Pathology, Stanley Medical College Hospital, and Global Health City, Chennai
› Author Affiliations
Further Information

Publication History

Publication Date:
26 September 2019 (online)

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ABSTRACT

Background and objectives: Proton pump inhibitors are used widely for gastroesophageal reflux disease and ulcer type dyspepsia. Majority of the patients require long term medication. H2 receptor antagonist are also used for relief of symptoms. Though tachyphylaxis has been reported, symptom response is seen with long term use. The aim of the present study was to study the effects of long-term acid suppressants on gastric antral histology.

Methods: Patients who received long-term acid suppressants such as ranitidine and omeprazole for gastroesophageal reflux disease or dyspepsia were included. All of them had an antral biopsy for histology and H. pylori status at baseline, at 6 months and 12 months. Patients on acid suppressants for less than a year or on long-term non-steroidal anti inflammatory drugs were excluded from the study. The grading of gastritis was classified as chronic active gastritis, atrophic gastritis, intestinal metaplasia and dysplasia.

Results: Thirty patients received ranitidine and 28 omeprazole. In H. pylori positive group, the median duration of ranitidine and omeprazole were 3 years (1.5 to 8 years) and 4 years (1 to 10 years) respectively. Two thirds of patients had chronic active gastritis (ranitidine: 35.5% omeprazole:26.6%); 10 had gastric atrophy (ranitidine: 6.6% omeprazole:15.5%) and 7 had intestinal metaplasia (ranitidine4.4% omeprazole11.1%). Four of the 10 patients on omeprazole showed progression of histology as against only one of the 13 patients on ranitidine at one year of follow up. In omeprazole pylori negative patients, the median duration of ranitidine and omeprazole was 2.5 years (range 1 to 6 years) and 3 years (range 2 to 7 years) respectively. Irrespective of the acid suppressants, the baseline histology was either chronic active gastritis (78.5%) or gastric atrophy (21.5%). None had intestinal metaplasia. Also there was no progression in histology staging during the follow up.

Conclusions: Long-term acid suppressants irrespective of the H. pylori status are not associated with significant histological changes in gastric mucosa. Despite a significant drop out of cases, among the cases followed up no significant progression in histological staging was seen during a one year follow-up. (J Dig Endosc 2013;4(1):1–5)

Key Words:

Gastric histology - Upper GI endoscopy - Omeprazole - Ranitidine - Gastric atrophy
 

  • References

  • 1 Ali T, Roberts DN, Tierney WM. Long term safety concerns with proton pump inhibitors. Am J Med 2009;122:896-903
  • 2 Attard TM, Yardley JH, Cuffari C. Gastric polyps in pediatrics: an 18-year hospital-based analysis. Am J Gastroenterol 2002;97:298-301
  • 3 Jalving M, Koornstra JJ, Wesseling J, Boezen HM, DE Jong S, Kleibeuker JH. Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy. Aliment Pharmacol Ther 2006;24:1341-8.
  • 4 Schenk BE, Kuipers EJ, Klinkenberg-Knol EC, Bloemena E, Nelis GF, Festen HP, et al. Hyper-gastrinaemia during long-term omeprazole therapy: influences of vagal nerve function, gastric emptying and Helicobacter pylori infection. Aliment Pharmacol Ther 1998;12:605-12.
  • 5 Drut R, Altamirano E, Cueto Rúa E. Omeprazole-associated changes in the gastric mucosa of children. J Clin Pathol 2008; 61:754-6.
  • 6 Geboes K, Dekker W, Mulder CJ, Nusteling K. Long term lansoprazole treatment for gastro-oesophageal reflux disease: clinical efficacy and influence on gastric mucosa. Aliment Pharmacol Ther 2001;15:1819-1826.
  • 7 Sanduleanu S, Jonkers D, De Bruine A, Hameeteman W, Stockbrügger RW. Double gastric infection with Helicobacter pylori and non-Helicobacter pylori bacteria during acid-suppressive therapy: increase of pro-inflammatory cytokines and development of atrophic gastritis. Aliment Pharmacol Ther 2001;15:1163-75.
  • 8 Chourasia D, Misra A, Pandey R, Ghoshal UC. Gastric atrophy and intestinal metaplasia in a patient on long term proton pum inhibitor therapy. Tropical Gastroenterology 2008; 29:172-4.
  • 9 Kuipers EJ. Proton pump inhibitors and gastric neoplasia. Gut 2006;55:1217-21.
  • 10 Uemura N, Okamoto S, Yamamoto S, Matsumura N, Yamaguchi S, Yamakido M, et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 2001; 345:784-9.
  • 11 Rugge M, Genta RM. Staging and grading of chronic gastritis. Human Pathology 2005;36:228 - 33.
  • 12 Alan BR Thomson, Michel D Sauve, Narmin Kassam, Holly Kamitakahara. Safety of the long-term use of proton pump inhibitors. World J Gastroenterol 2010;16:2323-30.
  • 13 Rajesh Prabhu P, Arunkumar K, Vimala R, Jayanthi V. Long term acid suppression therapy: its influence on gastric mucosa. Euroasian J Hepato Gastroenterol 2013;3:19-22.
  • 14 Haber MM, Hunt B, Freston JW, Peura DA, Kovacs TO, Atkinson S et al. Changes of Gastric Histology in Patients with Erosive Oesophagitis Receiving Long-term lansoprazole maintenance Therapy. Aliment Pharmacol Therap 2010;32:83-96.
  • 15 Diebold MD, Richardson S, Duchateau A, Bigard MA, Colin R, Cortot A et al. Factors influencing corpus argyrophil cell density and hyperplasia in reflux esophagitis patients treated with antisecretory drugs and controls. Dig Dis Sci 1998;43: 1629-35.
  • 16 Lundell L, Havu N, Miettinen P, Myrvold HE, Wallin L, Julkunen R, et al. Changes of gastric mucosal architecture during long-term omeprazole therapy: results of a randomized clinical trial. Aliment Pharmacol Ther 2006;23:639-47.
  • 17 Lamberts R, Brunner G, Solcia E. Effects of very long (up to 10 years) proton pump blockade on human gastric mucosa. Digestion 2001;64:205-13.
  • 18 Kuipers EJ, Lundell L, Klinkenberg-Knol EC, Havu N, Festen HP, Liedman B et al. Atrophic gastritis and Helicobacter pylori infection in patients with reflux esophagitis treated with omeprazole or fundoplication. N Engl J Med 1996;334:1018-22.
  • 19 Lundell L, Miettinen P, Myrvold HE, Pedersen SA, Thor K, Andersson A et al. Lack of effect of acid suppression therapy on gastric atrophy. Nordic GERD Study Group. Gastroenterology 1999;117:319-26.
  • 20 Kuipers EJ, Uyterlinde AM, Peña AS, Roosendaal R, Pals G, Nelis GF, et al. Long-term sequelae of Helicobacter pylori gastritis. Lancet 1995;345:1525-8.
  • 21 Klinkenberg-Knol EC, Nelis F, Dent J, Snel P, Mitchell B, Prichard P, et al. Long-term omeprazole treatment in resistant gastroesophageal reflux disease: efficacy, safety, and influence on gastric mucosa. Gastroenterology 2000;118:661-9.
  • 22 Moayyedi P, Wason C, Peacock R, Walan A, Bardhan K, Axon AT, et al. Changing patterns of Helicobacter pylori gastritis in long-standing acid suppression. Helicobacter 2000;5:206-14.
  • 23 Hirschowitz BI. Pernicious anemia and stomach cancer. Scand J Gastroenterol 2001;36:896.
  • 24 Uemura N, Okamoto S, Yamamoto S, Matsumura N, Yamaguchi S, Mashiba Omeprazole, et al. Changes in Helicobacter pylori-induced gastritis in the antrum and corpus during long-term acid-suppressive treatment in Japan. Aliment Pharmacol Ther 2000;14:1345-52.
  • 25 Ohkusa T, Fujiki K, Takashimizu I, Kumagai J, Tanizawa T, Eishi Y, et al. Improvement in atrophic gastritis and intestinal metaplasia in patients in whom Helicobacter pylori was eradicated. Ann Intern Med 2001;134: 380-6.
  • 26 Kuipers EJ, Nelis GF, Klinkenberg-Knol EC, Snel P, Goldfain D, Kolkman JJ, et al. Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial. Gut 2004;53: 12-20.
  • 27 Kuipers EJ. Proton pump inhibitors and Helicobacter pylori gastritis: friends or foes? Basic Clin Pharmacol Toxicol 2006; 99: 187-94.
  • 28 Malfertheiner P, Megraud F, O′Morain C, Bazzoli F, El-Omar E, Graham D, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007;56:772-81.
  • 29 Robinson M. Drugs, bugs, and esophageal pH profiles. Yale J Biol Med 1999;72:169-72.
  • 30 Stolte M, Meining A, Schmitz JM, Alexandridis T, Seifert E. Changes in Helicobacter pylori-induced gastritis in the antrum and corpus during 12 months of treatment with omeprazole and lansoprazole in patients with gastro-oesophageal reflux disease. Aliment Pharmacol Ther 1998;12: 247-53.
  • 31 McColl KE, Murray LS, Gillen D. Omeprazole and accelerated onset of atrophic gastritis. Gastroenterology 2000; 18:239.
  • 32 McColl KE. Helicobacter pylori infection and long term proton pump inhibitor therapy. Gut 2004;53:5-7.
  • 33 Gillen D, McColl KE. Problems associated with the clinical use of proton pump inhibitors. PharmacolToxicol 2001;89: 281-6.
  • 34 Singh P, Indaram A, Greenberg R, Visvalingam V, Bank S. Long term omeprazole therapy for reflux esophagitis: follow-up in serum gastrin levels, EC cell hyperplasia and neoplasia. World J Gastroenterol 2000;6:789-92.
  • 35 Ali T, Roberts DN, Tierney WM. Long-term safety concerns with proton pump inhibitors. Am J Med 2009;122:896-903.