Mathieu Nicolas
Clinique universitaire d'hépato-gastroentérologie, pôle Digidune, CHU de Grenoble, Université de Grenoble, 38043 Grenoble Cedex, France.
Rev Prat. 2008 Sep 15;58(13):1451-4.
Proton pump inhibitors (PPIs) have become the mainstay of therapy in acid-related upper gastrointestinal disorders including gastroesophageal reflux disease and peptic ulcer disease. Alltough these medications are generally accepted as safe, the long-term clinical consequences of the inducing hypochlorhydria are not completely clear. Gastric acid production is mainly controlled by the hormone gastrin through a negative feedback in which hypochlorhydria induces an increase in serum gastrin. PPIs have been shown to increase serum gastrin levels. Gastric endocrine cell hyperplasia can occur in 10 to 30% of patients without carcinoid tumors. Recent studies indicate no association between PPI use and the risk of colorectal and gastric cancers. Proton pump inhibitor-associated gastric polyps are totally benign tumors that should not be followed. There is an association between PPIs-induced acid suppression and an increased risk of enteric infection. PPIs do not inhibit intestinal absorption of lipids, iron, phosphorus, magnesium or zinc from food but can affect vitamin B12 status in older patients. Despite the undoubted benefits of PPIs, the practitioner always needs to consider risks and benefits before initiating them.
质子泵抑制剂（PPIs）已成为治疗包括胃食管反流病和消化性溃疡病在内的酸相关性上消化道疾病的主要药物。尽管这些药物通常被认为是安全的，但诱导胃酸过少的长期临床后果尚不完全清楚。胃酸分泌主要由胃泌素通过负反馈控制，其中胃酸过少会导致血清胃泌素增加。已证明质子泵抑制剂会增加血清胃泌素水平。10%至30%无类癌肿瘤的患者可发生胃内分泌细胞增生。最近的研究表明，使用质子泵抑制剂与结直肠癌和胃癌风险之间没有关联。质子泵抑制剂相关的胃息肉是完全良性的肿瘤，无需随访。质子泵抑制剂引起的胃酸抑制与肠道感染风险增加之间存在关联。质子泵抑制剂不抑制食物中脂质、铁、磷、镁或锌的肠道吸收，但会影响老年患者的维生素B12状态。尽管质子泵抑制剂有毋庸置疑的益处，但从业者在开始使用前始终需要考虑风险和益处。
