Risks of anti-Helicobacter therapy and long-term therapy with antisecretory drugs

Abstract

Helicobacter pylori (H. pylori) infection has a protective effect on gastroesophageal reflux disease (GERD). Both of these diseases have a very high incidence and prevalence. As a result, GERD often recurs after anti-Helicobacter therapy. The problem of effective treatment of H. pylori infection and GERD is that the main groups of drugs [proton pump inhibitors (PPIs) and potassium-competitive acid blockers] have the possibility of side effects with use. Such supposed side effects have no evidence in randomized controlled trials that comply with the principles of evidence-based medicine. Morphological changes in the gastric mucosa after long-term use of antisecretory drugs should be considered as compensatory mechanisms of sanogenesis. The greatest concern for doctors who treat patients with antisecretory drugs is the risk of gastric carcinogenesis. This article presents an analysis of morphological and pathophysiological changes that occur after long-term use of antisecretory drugs (PPIs). Hypertrophy (hyperplasia) of G cells, enterochromaffin-like cells and possible fundic gland polyps (hyperplasia) are compensatory mechanisms of sanogenesis during long-term treatment with PPIs. These mechanisms are of primary importance for rehabilitation and prevention of complications in patients with GERD, non-steroidal anti-inflammatory drugs-gastropathy and other diseases during long-term treatment with PPIs. Understanding the pathophysiological and morphological mechanisms of compensation and adaptation, the mechanisms of sanogenesis and carcinogenesis will increase the number of indications for long-term use of PPIs with a high level of efficiency and safety of treatment. In addition, understanding the pathophysiological and morphological mechanisms of compensation and adaptation, the mechanisms of sanogenesis will allow us to forecast the side effects of long-term use of potassium-competitive acid blockers.

Keywords: Epidemiology; Gastroesophageal reflux disease; Proton pump inhibitor; Potassium-competitive acid blocker; Risk-benefit; Gastroprotection; Compensatory mechanisms; Helicobacter pylori infection; Sanogenesis

Core Tip: Helicobacter pylori (H. pylori) infection has a protective effect on gastroesophageal reflux disease. Both of these diseases have a very high incidence and prevalence. The main obstacle to effective treatment H. pylori infection and gastroesophageal reflux disease is the possible side effects after use of proton pump inhibitors (PPIs). The article provides a precise analysis of scientific reviews and meta-analyses, as well as experimental scientific morphological studies on this topic. The author presented his original field of vision. He convincingly substantiated his opinion, proposed to interpret possible morphological and functional changes in the gastric mucosa after long-term use of PPIs as compensatory mechanisms of sanogenesis. This field of view will increase the number of indications for the use of PPIs and other antisecretory drugs.