Marked increase in gastric acid secretory capacity after omeprazole treatment.
Open accessAbstract
BACKGROUND: In contrast with the histamine2 (H2) blockers, proton pump inhibitors have not been shown to give rebound hypersecretion of acid. Taking into consideration the hyperplasia of the enterochromaffin-like (ECL) cell provoked by hypergastrinaemia secondary to profound acid inhibition and the central role of histamine from ECL cells in the regulation of acid secretion, the lack of any rebound acid hypersecretion after treatment with proton pump inhibitors has been questioned. AIMS: To reassess the effect of treatment with omeprazole on post-treatment acid secretion. METHODS AND PATIENTS: Basal and pentagastrin stimulated acid secretion were determined in nine patients with reflux oesophagitis before and 14 days after termination of a 90 day treatment period with the proton pump inhibitor omeprazole (40 mg daily). Basal gastrin release were determined before and during omeprazole treatment. Furthermore, biopsy samples from the oxyntic mucosa were taken before and at the end of the treatment period for chemical (histamine and chromogranin A (CgA)) evaluation of the ECL cell mass. RESULTS: A substantial increase in meal stimulated gastrin release during omeprazole treatment resulted in an increased ECL cell mass. Furthermore, CgA in serum increased during omeprazole treatment suggesting that serum CgA may be used as a test to evaluate ECL cell hyperplasia. A significant increase in basal and a marked (50%) and significant increase in pentagastrin stimulated acid secretion were found after treatment with omeprazole. CONCLUSIONS: Increased acid secretion after a conventional treatment period with a proton pump inhibitor is probably due to ECL cell hyperplasia and may have negative consequences for acid related diseases.
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Proton pump inhibitors (PPI) and histamine H2-receptor blockers are important factors influencing CgA concentrations.
“One important factor is gastric acid suppressive therapy by proton pump inhibitors (PPI) and histamine H 2 -receptor blockers (4, 5).”
From Effect of Short-Term Proton Pump Inhibitor Treatment and Its Discontinuation on Chromogranin A in Healthy Subjects (2012) · cites this paper as [4]
The Abstract and the section on plasma gastrin report that serum CgA increased during omeprazole treatment, supporting the PPI part of the claim. The paper mentions H2 blockers in relation to acid secretion, but does not report that they influence CgA concentrations. (LLM, conf=0.88)
Experimental — accuracy not yet measuredDecrease in acidity leads to release of gastrin.
“These studies suggested that decrease in acidity leads to release of gastrin.”
From Discontinuation of proton pump inhibitors during assessment of chromogranin A levels in patients with neuroendocrine tumours (2011) · cites this paper as Waldum et al, 1996
Elevated gastrin leads to hyperplasia of ECL cells and subsequently to an increase in chromogranin A levels.
“Elevated gastrin leads to hyperplasia of ECL cells and, subsequently, to an increase in CgA levels (Waldum et al, 1996; Sanduleanu et al, 1999).”
From Discontinuation of proton pump inhibitors during assessment of chromogranin A levels in patients with neuroendocrine tumours (2011) · cites this paper as Waldum et al, 1996
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“Elevated gastrin leads to hyperplasia of ECL cells and, subsequently, to an increase in CgA levels (Waldum et al, 1996; Sanduleanu et al, 1999).”
BackgroundThe Enterochromaffin-like [ECL] Cell—Central in Gastric Physiology and Pathology
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- Authors
- Waldum, H. L., Arnestad, J. S., Brenna, E., Eide, I., Syversen, U., & Sandvik, A. K.
- Venue
- Gut
- Publisher
- BMJ
- Published
- 1996-11
- Volume
- 39
- Issue
- 5
- Pages
- 649-653
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC1383386
- OpenAlex
- W2015180374
- Semantic Scholar
- c8848c93faa5d449fd0db3ef3d47e87b5a850d64
- Cited by
- 243
- References
- 37
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 7 · 2023: 5 · 2022: 4 · 2021: 6 · 2020: 5 · 2019: 8 · 2018: 12 · 2017: 11 · 2016: 9 · 2015: 5 · 2014: 6 · 2013: 12 · 2012: 14
- FWCI
- 10.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gut (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
- Health Sciences › Medicine › Surgery › Helicobacter pylori-related gastroenterology studies
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- omeprazole, proton pump inhibitors, rebound acid hypersecretion, gastric acid secretion, enterochromaffin-like cells, ECL cell hyperplasia, gastrin release, chromogranin A, reflux esophagitis, pentagastrin stimulation, oxyntic mucosa, histamine
- MeSH terms
- Adult, Aged, Anti-Ulcer Agents, Chromogranins, Enterochromaffin Cells, Esophagitis, Peptic, Gastric Acid, Gastric Mucosa, Humans, Hyperplasia, Male, Middle Aged, Omeprazole, Pentagastrin, Chromogranin A, Proton Pump Inhibitors
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