OBJECTIVE: The recent description of dyspepsia in healthy individuals after stopping treatment with proton-pump inhibitors (PPIs) indicates that reflux disease may worsen due to this treatment. The aim of this paper is to review current knowledge of the regulation of gastric acid secretion, including maximal acid secretion, and to improve understanding of the pathogenesis of acid-related conditions. MATERIAL AND METHODS: We reviewed our findings from three decades of studies on gastric acid secretion in the isolated rat stomach and in humans as well as studies by the group of Robert Jensen involving gastrinoma patients. RESULTS: The parietal cell has receptors for histamine and acetylcholine, whereas the gastrin receptor is localized to the enterochromaffin-like (ECL) cell. Gastrin-stimulated histamine release depends on the ECL cell mass, which is regulated by gastrin. The parietal cell mass is also influenced by gastrin. All conditions with hypergastrinemia concomitant with a normal oxyntic mucosa result in an increase in acid secretion. Helicobacter pylori infection in the antral mucosa may induce duodenal ulcers by its effect on acid secretion, as in patients with gastrinoma. Whereas PPIs induce clinically important rebound acid hypersecretion, histamine-2 blockers do not, since they also induce tolerance. CONCLUSION: From a biological and physiological point of view, patients should be given treatment that disturbs the normal physiology as little as possible.
OBJECTIVE: The recent description of dyspepsia in healthy individuals after stopping treatment with proton-pump inhibitors (PPIs) indicates that reflux disease may worsen due to this treatment. The aim of this paper is to review current knowledge of the regulation of gastric acid secretion, including maximal acid secretion, and to improve understanding of the pathogenesis of acid-related conditions. MATERIAL AND METHODS: We reviewed our findings from three decades of studies on gastric acid secretion in the isolated rat stomach and in humans as well as studies by the group of Robert Jensen involving gastrinomapatients. RESULTS: The parietal cell has receptors for histamine and acetylcholine, whereas the gastrin receptor is localized to the enterochromaffin-like (ECL) cell. Gastrin-stimulated histamine release depends on the ECL cell mass, which is regulated by gastrin. The parietal cell mass is also influenced by gastrin. All conditions with hypergastrinemia concomitant with a normal oxyntic mucosa result in an increase in acid secretion. Helicobacter pylori infection in the antral mucosa may induce duodenal ulcers by its effect on acid secretion, as in patients with gastrinoma. Whereas PPIs induce clinically important rebound acid hypersecretion, histamine-2 blockers do not, since they also induce tolerance. CONCLUSION: From a biological and physiological point of view, patients should be given treatment that disturbs the normal physiology as little as possible.
Authors: Jasmohan S Bajaj; I Jane Cox; Naga S Betrapally; Douglas M Heuman; Mitchell L Schubert; Maiyuran Ratneswaran; Phillip B Hylemon; Melanie B White; Kalyani Daita; Nicole A Noble; Masoumeh Sikaroodi; Roger Williams; Mary M E Crossey; Simon D Taylor-Robinson; Patrick M Gillevet Journal: Am J Physiol Gastrointest Liver Physiol Date: 2014-09-25 Impact factor: 4.052
Authors: Hólmfridur Helgadóttir; Sigrún H Lund; Sveinbjörn Gizurarson; David C Metz; Einar S Björnsson Journal: J Clin Gastroenterol Date: 2020-03 Impact factor: 3.062
Authors: E Gould; C Clements; A Reed; L Giori; J M Steiner; J A Lidbury; J S Suchodolski; M Brand; T Moyers; L Emery; M K Tolbert Journal: J Vet Intern Med Date: 2016-04-08 Impact factor: 3.333
Authors: Óskar Ö Hálfdánarson; Anton Pottegård; Einar S Björnsson; Sigrún H Lund; Margret H Ogmundsdottir; Eiríkur Steingrímsson; Helga M Ogmundsdottir; Helga Zoega Journal: Therap Adv Gastroenterol Date: 2018-05-30 Impact factor: 4.409