Changes of gastric mucosal architecture during long-term omeprazole therapy: results of a randomized clinical trial
Article first published online: 14 FEB 2006
Alimentary Pharmacology & Therapeutics
Volume 23, Issue 5, pages 639–647, March 2006
How to Cite
LUNDELL, L., HAVU, N., MIETTINEN, P., MYRVOLD, H. E., WALLIN, L., JULKUNEN, R., LEVANDER, K., HATLEBAKK, J. G., LIEDMAN, B., LAMM, M., MALM, A., WALAN, A. and THE NORDIC GERD STUDY GROUP (2006), Changes of gastric mucosal architecture during long-term omeprazole therapy: results of a randomized clinical trial. Alimentary Pharmacology & Therapeutics, 23: 639–647. doi: 10.1111/j.1365-2036.2006.02792.x
- Issue published online: 14 FEB 2006
- Article first published online: 14 FEB 2006
- Publication data Submitted 15 July 2005 First decision 12 August 2005 Resubmitted 17 November 2005 Resubmitted 28 November 2005 Resubmitted 8 December 2005 Accepted 9 December 2005
Background The impact of long-term acid suppression on the gastric mucosa remains controversial.
Aim To report further observations on an established cohort of patients with gastro-oesophageal reflux disease, after 7 years of follow-up.
Methods Of the original cohort randomized to either antireflux surgery or omeprazole, 117 and 98 patients remained in the medical and surgical arms, respectively. Gastric biopsies were taken at baseline and throughout the study.
Results Fifty-three antireflux surgery and 39 omeprazole-treated patients had Helicobacter pylori infection at randomization. Eighty-three omeprazole-treated and 60 antireflux surgery patients remained H. pylori negative over the 7 years, and no change was observed in mucosal morphology except for a change in endocrine cell population (linear and diffuse hyperplasia, P = 0.03). During the 7-year study many patients, who were initially H. pylori infected, had the infection eradicated leaving only 13 omeprazole and 12 antireflux surgery patients still infected. In these patients, omeprazole induced a deterioration of the mucosal inflammation scores (P = 0.01) with a numerical increase of glandular atrophy.
Conclusions Long-term omeprazole therapy does not alter the exocrine oxyntic mucosal morphology in H. pylori-negative patients, but mucosal endocrine cells appear to be under proliferative stimulation; in H. pylori-positive patients there are changes in mucosal inflammation and atrophy.