[Modification of the growth of the gastric mucosa by drugs]

Over the last two decades it has become apparent that various drugs influence growth of gastric mucosa. For example, non-steroidal anti-inflammatory drugs increase cell shedding, which is, in rats at least, overcompensated by stimulation of cell proliferation during long-term treatment. Hyperplasia of parietal and other gastric epithelial cells has been observed in rats treated with many different ulcer drugs. Of special interest are alterations and sometimes neoplasms of gastric mucosa induced by long-term administration of very high doses of novel inhibitors of acid secretion. Some of these tumours are probably the consequence of massive hypergastrinaemia due to alkaline gastric pH and consequent lack of inhibition of gastrin release. In man the increase of gastrin is less marked even after administration of omeprazole, the most potent inhibitor of acid secretion known. Extrapolation of results from animal experiments to the situation of patients with ulcer disease is therefore questionable. However, it cannot be ruled out that total inhibition of acid secretion for a very long period could cause proliferation of gastric endocrine cells, since such tumours occur in endogenous hypergastrinaemia in patients with pernicious anaemia or Zollinger-Ellison syndrome.