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Sustained suppression of gastric secretion and the risk of neoplasia in the gastric mucosa.

Long-term risks of medications that cause profound and sustained suppression of acid secretion are an increasing source of concern. Because of concerns over a potentially increased incidence of gastric malignancies in patients with pernicious anemia, clinicians have become increasingly aware of changes in gastric flora, and levels of carcinogen, as well as changes in hormonal milieu, which can accompany profound suppression of acid secretion. The risks of gastric epithelial and endocrine cell neoplasia in patients receiving powerful antisecretory agents are not yet known, but cannot be dismissed until long-term follow-up studies are available. The relationship between proliferation of epithelial and endocrine elements and sustained suppression of acid secretion may provide new insight into processes that regulate replication and growth of cells in the gastric mucosa.