Department of Gastroenterology, Rabin Medical Center, Tel Aviv University, 39 Jabotinski Street, Petach Tikva 49100, Israel.
Med Hypotheses. 2011 Sep;77(3):451-2. doi: 10.1016/j.mehy.2011.06.007. Epub 2011 Jul 1.
Gastro esophageal reflux disease and ulcer related or non-ulcer dyspepsia, attacks 20% of the Western population. These millions of patients are treated continuously with PPI for different periods, many for many years. Recently, rebound acid hypersecretion was recognized as a major clinical event after cessation of PPI therapy. Sustained hypergastrinemia due to daily PPI therapy causes increased acid-secretory capacity that appears when the drug is stopped. The transient increase in blood and urinary pH following gastric secretion has been termed the alkaline tide phenomenon. Carbonic acid, formed in the presence of the enzyme carbonic anhydrase, neutralizes intracellular hydroxyl ions produced as a result of luminal acid secretion. The bicarbonate generated is removed from the cell via the baso-lateral chloride bicarbonate exchanger. We have shown in several studies that this phenomenon parallels acid secretion. Thus, stimulation of acid secretion with test meal increased base excess maximally after 45 min and these changes parallel peak acid output measured in gastric aspirate. We hypothesize that gradual step down cessation of PPI will prevent this clinical relevant event. By measuring alkaline tide after PPI cessation we may prove this hypothesis.
胃食管反流病和溃疡相关或非溃疡性消化不良，侵袭了 20%的西方人群。这数百万患者持续接受不同时间长度的 PPI 治疗，许多人甚至多年接受治疗。最近，人们认识到 PPI 治疗停止后胃酸过度分泌是一个主要的临床事件。由于每天的 PPI 治疗导致持续性高胃泌素血症，从而在停药时出现胃酸分泌能力增加。胃分泌后的血液和尿液 pH 值短暂增加被称为碱潮现象。在碳酸酐酶的存在下形成的碳酸中和了由于管腔酸分泌而产生的细胞内羟基离子。生成的碳酸氢盐通过基底外侧氯离子碳酸氢盐交换器从细胞中去除。我们在几项研究中表明，这种现象与胃酸分泌平行。因此，用试验餐刺激胃酸分泌，最大碱剩余在 45 分钟后增加，这些变化与胃抽吸中测量的最大胃酸分泌峰值平行。我们假设逐渐减少 PPI 的剂量可以预防这种与临床相关的事件。通过测量 PPI 停药后的碱潮，我们可能会验证这一假设。
