Safety of proton-pump inhibitors: the acid test

It is well established that atrophic gastritis, pernicious anaemia and partial gastrectomy are associated with an increased risk of gastric carcinoma. These conditions all result in a low acid output state. Although the mechanism of gastric carcinogenesis is not known, the model proposed by Correa has provided the most attractive explanation to date. The suggestion is that prolonged hypochlorhydria predisposes to gastric carcinoma by an increase in the production of carcinogenic N-nitroso compounds. This hypothesis has led to concerns about the safety of long-term acid suppression in the management of a variety of acid-related gastrointestinal conditions.