Insights into Effects/Risks of Chronic Hypergastrinemia and Lifelong PPI Treatment in Man Based on Studies of Patients with Zollinger–Ellison Syndrome
Abstract
:1. Introduction
2. Chronic Hypergastrinemia: General
3. Why is Chronic Hypergastrinemia from PPI Use Receiving Increased Attention and Generating Continued Debate?
4. Why is Prolonged PPI Use Receiving Increased Attention and Generating Continued Debate?
5. Why Would Results from the Long-Term Study of Zollinger–Ellison Syndrome (ZES) Provide Useful Insights into the Issue of Safety of Chronic Hypergastrinemia from Lifelong Use of PPIs in nonZES Patients?
6. Insights of Effects of Chronic Hypergastrinemia in Patients with ZES
6.1. Gastric Mucosal Effects in ZES Patients
6.1.1. Gastric Mucosal Effects in ZES Patients; Non-Endocrine Cells
6.1.2. Gastric Mucosal Effects in ZES Patients: ECL Cells and Gastric Carcinoids
Gastric Mucosal Effects in Sporadic ZES Patients: ECL Cells and Gastric Carcinoids (Table 1)
Gastric Mucosal Effects in MEN1/ZES Patients: ECL Cells and Gastric Carcinoids (Table 1)
Gastric Mucosal Effects in ZES Patients: ECL Cells and Gastric Carcinoids-Sporadic ZES versus MEN1/ZES
Gastric Mucosal Effects in ZES Patients: Comparison with Results from Studies of Chronic Hypergastrinemia in Animals, ECL Cell Changes Reported with Chronic PPI/Potent Anti-Secretory Drug Use, and ECL Cell Changes in Other Common Chronic Hypergastrinemic States (CAG/PA) in Man
6.2. Other Effects of Chronic Hypergastrinemia in ZES
6.2.1. Other Effects of Chronic Hypergastrinemia in ZES: Gastrin and Esophageal adenocarcinoma (Table 1)
6.2.2. Other Effects of Chronic Hypergastrinemia in ZES: Gastrin and Gastric Adenocarcinoma (Table 1)
6.2.3. Other Effects of Chronic Hypergastrinemia in ZES: Gastrin and Colorectal Cancer (CRC) (Table 1)
6.2.4. Other Effects of Chronic Hypergastrinemia in ZES: Gastrin and Pancreatic Cancer (Table 1)
6.3. ZES as Model for Long-Term PPI Effects (Safety, Side-Effects, Effectiveness)
6.3.1. Why is There a Need for Assessment of Long PPI Effects Particularly Related to Safety and Side-Effects?
6.3.2. Why Could Results from the Long-Term Study of Zollinger–Ellison Syndrome (ZES) Provide Useful Insights into the Issues of Long-Term PPI Effects (Safety, Side-Effects, Effectiveness) in nonZES Patients?
6.3.3. Chronic PPI Treatment and Nutrient Malabsorption (vitamin B12 (VB12), Iron, Calcium, Magnesium [Mg]) (Table 1)
Chronic PPI Treatment and Nutrient Malabsorption (VB12, Iron, Calcium, Mg): General
Chronic PPI Treatment and Nutrient Malabsorption: VB12 (Table 1)
Chronic PPI Treatment and Nutrient Malabsorption: Iron (Table 1)
Chronic PPI Treatment and Nutrient Malabsorption: Mg (Table 1)
Chronic PPI Treatment and Nutrient Malabsorption: Calcium (Table 1)
6.3.4. Chronic PPI Treatment and Other Reported PPI Side-Effects and Insights from Studies of ZES Patients (Table 1)
7. Conclusions
Author Contributions
Funding
Conflicts of Interest
Abbreviations
BE | Barrett’s esophagus |
CCK2R | Cholecystokinin type 2 receptor (gastrin receptor) |
CgA | Chromogranin A |
CGA/PA | Chronic atrophic gastritis/pernicious anemia |
CRC | Colorectal cancer |
EAC | Esophageal adenocarcinoma |
ECL cell | Gastric enterochromaffin-like cells |
FSG | Fasting gastrin concentration |
GC | Gastric cancer |
GER | Gastroesophageal reflux disease |
Gly-gastrin | Glycine-extended gastrin |
HP | Helicobacter pylori |
Mg | Magnesium |
MEN1/ZES | Multiple Endocrine Neoplasia type 1 with ZES |
PDAC | Pancreatic ductal adenocarcinoma |
PPI | Proton pump inhibitor |
VB12 | Vitamin B12 |
ZES | Zollinger–Ellison syndrome |
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Potential PPI Side-Effect | Potential Mechanism | Insights from ZES Studies |
---|---|---|
General Why ZES useful model of Chr HG | Chronic hypergastrinemia (Chr. HG) |
|
General Why ZES useful model of long-term PPI use | Lifelong need for potent gastric antisecretory drugs—PPIs drug of choice |
|
ECL hyperplasia/gastric carcinoids | Chronic hypergastrinemia (Chr. HG) |
|
Esophageal, gastric, pancreatic adenocarcinomas | Chronic hypergastrinemia (Chr. HG) |
|
Colorectal cancer | Chronic hypergastrinemia (Chr. HG) |
|
Nutrient malabsorption (Fe, Ca) | PPI-induced Hypo-/Achlorhydria |
|
Nutrient malabsorption (VB12) | PPI-induced Hypo-/Achlorhydria |
|
Hypomagnesemia | Unclear = mechanism |
|
Bone fractures | Unclear = mechanism |
|
Rebound hypersecretion after stopping PPI | Unclear = mechanism |
|
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Lee, L.; Ramos-Alvarez, I.; Ito, T.; Jensen, R.T. Insights into Effects/Risks of Chronic Hypergastrinemia and Lifelong PPI Treatment in Man Based on Studies of Patients with Zollinger–Ellison Syndrome. Int. J. Mol. Sci. 2019, 20, 5128. https://doi.org/10.3390/ijms20205128
Lee L, Ramos-Alvarez I, Ito T, Jensen RT. Insights into Effects/Risks of Chronic Hypergastrinemia and Lifelong PPI Treatment in Man Based on Studies of Patients with Zollinger–Ellison Syndrome. International Journal of Molecular Sciences. 2019; 20(20):5128. https://doi.org/10.3390/ijms20205128
Chicago/Turabian StyleLee, Lingaku, Irene Ramos-Alvarez, Tetsuhide Ito, and Robert T. Jensen. 2019. "Insights into Effects/Risks of Chronic Hypergastrinemia and Lifelong PPI Treatment in Man Based on Studies of Patients with Zollinger–Ellison Syndrome" International Journal of Molecular Sciences 20, no. 20: 5128. https://doi.org/10.3390/ijms20205128