Pros and cons of long-term use of PPI — an editorial

Abstract

The parietal cells of stomach secrete hydrochloric acid which is important not only for sterilization of bacteria contained in ingested foods, but also essential for digestion and absorption of various nutritients, such as iron, calcium, vitamin B12, and protein,. Gastric acid secretion is a multifactorial and complex process regulated by at least three different pathways upon the parietal cell. These pathways include the paracrine secretion of gastrin and histamine, as well as the actions of postganglionic muscarinic acetylcholine. As the secreted acid may damage the gastrointestinal tract, various types of protective mechanisms, including mucosal mucous/bicarbonate secretion and sphincter contraction of the gastroesophageal junction, are present to prevent gastric acid-induced gastroesophageal damage. When these protective mechanisms are overcome by acid secretion, gastrointestinal mucosa can become irritated and damaged, resulting in unpleasant symptoms or even organic diseases i.e. acid-related diseases. Acid-related diseases include gastric and duodenal ulcers, gastroesophageal reflux disease (GERD), Barrett’s esophagus, Zollinger-Ellison syndrome and functional dyspepsia. Neutralizing agents and various inhibitors of gastric acid secretion have been developed for treatment of acid-related diseases. There is a long history of development of various drugs for acid-related diseases; initially, neutralizing drugs containing aluminum or magnesium, were developed, then anti-cholinergic agents. Then, Histamine2-receptor antagonists (H2RAs) were introduced for treatment. Proton pump inhibitor (PPI)- omeprazole was first introduced in 1989, and have steadily become the main drug  for treatment of acid-related disorders. Six PPIs are approved by the United States Food and Drug Administration (FDA) in 2015 ^[1].  ATPase) and is the most potent inhibitor of acid secretion ^{[2, 3]}. PPIs have demonstrated excellent safety, consistent patient tolerance, and generally superior acid suppressing ability than other agents ^[2,4]. PPI represents the first choice of drugs for treatment of gastroesophageal reflux disease (GERD)...