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Omeprazole Therapy in Resistant Reflux Disease
- Elly Klinkenberg-Knol, MD;
- Stephan Meuwissen, MD; and
- Henk Festen, MD
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IN RESPONSE:
Drs. Waldum and Brenna express their concerns regarding omeprazole-induced hypergastrinemia. We have recommended continued follow-up of patients receiving long-term therapy with proton-pump inhibitors, particularly patients with high serum gastrin levels that showed enhanced progression toward atrophic gastritis. The significance of this finding remains unclear and requires further study. This follow-up strategy also applies to the risk for progression from hyperplasia to dysplasia of ECL cells.
Concerning the potential cause of food retention in patients with high gastrin levels, we have postulated that omeprazole might be responsible for the food retention caused by the decreased emptying rate of solid food in healthy volunteers [1-3]. Another explanation might be decreased antral motility [4] and delayed gastric emptying caused by elevated serum gastrin levels. Vagal nerve damage might also be among the factors causing delayed gastric emptying in some of our patients.
Drs. Wright and Sarich suggest that the severe hypergastrinemia observed in 10 of 91 patients receiving long-term omeprazole therapy might be caused by a difference in metabolism of the drug. If their hypothesis is correct, a lower dose of omeprazole should be needed in these patients to achieve remission. However, we did not observe a decreased need for the drug. In contrast, these patients experienced frequent recurrences during maintenance treatment with omeprazole (20 mg/d or 40 mg/d). In our opinion, the main cause of this severe hypergastrinemia is delayed gastric emptying.
Profound acid inhibition may interfere with the absorption of certain nutrients such as iron and cobalamin [5]. However, although the resorption of protein-bound cobalamin was found to decrease during omeprazole treatment, no changes in serum cobalamin levels were detected during continuous maintenance therapy that lasted as long as 4 years [5]. Similarly, no changes in several other metabolic measurements were found during long-term treatment.
We agree that conscientious behavior by physicians in prescribing proton-pump inhibitors, particularly in young patients, is still required.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
