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LONG TERM ACID SUPPRESSION THERAPY: IT’S INFLUENCE ON GASTRIC MUCOSA
P Rajesh Prabhu, R Selvasekaran, S Aravindh, S Chandramohan, G Pradeep, R Vimala*, A Murali, V Jayanthi
Department of Gastroenterology, Stanley Medical College, Chennai, *Department of Pathology, Coimbatore Medical College, Coimbatore, India
AIMS: Acid suppression with Proton pump inhibitors (PPI) or Histamine-2 receptor antagonists (H2RA) is indicated in the management of acid peptic disease. Often, patients require prolonged treatment with these drugs for symptom relief. Though considered safe, their long-term effect on the gastric mucosa is not known. The present study aimed to compare the effects of these drugs on the gastric mucosa.
METHODS: 126 cases including 66 on PPI (Gp I) and 60 on H2RA (Gp II) for over one year with normal endoscopy were included. Further 3 subgroups were based on the duration of treatment, Gp A: < 2 yrs, Gp B: 2-5 yrs and Gp C: > 5 yrs. Alcoholics, smokers and those with abnormal endoscopy were excluded. Tissue specimens from fundus, body and antrum of the stomach were obtained and the histology was compared.
RESULTS: M:F ratio –30:36 vs 28:32, mean age –39.9 ± 11.4 vs 40.6 ± 9.1 yrs, mean duration of therapy –38 ± 19.6 vs 42.8 ± 17.1 mo. among Gp I vs Gp II respectively. Histologically, in Gp I vs Gp II, H. pylori was positive in 24 (36.4%) vs 12 (20%) cases. Co-existing atrophy was present in 12 (50%) vs 4 (33.3%), pit abscess in 12 (50%) vs 2 (16.7%) and intestinal metaplasia in 7 (29.2%) vs none respectively (P<0.05). Fundus was the most common site of colonization i.e. 12 (50%) in Gp I vs 4 (33.3%) in Gp II, followed by body in 10 (41.7%) vs 2 (16.7%) and antrum in 10 (41.7%) vs 8 (66.6%) respectively (P<0.01). A statistically significant increase in H. pylori related atrophy, pit abscess and intestinal metaplasia of body and fundus were also noted in Gp I with increasing duration of PPI therapy.
CONCLUSION: Long-term acid suppression therapy was associated with H. pylori related gastric mucosal changes mainly in fundus and body. Histological worsening correlated with increasing duration of PPI when compared to H2RA. This had provided a new insight towards the management of H. pylori in such cases. i.e, Antral predominant gastritis would benefit from PPI containing anti H pylori regimen, which may be harmful in corpus predominant gastritis requiring H2RA containing regimen as an alternative. There may be a need for eradicating H. pylori in long term acid suppression for ulcer dyspepsia.