[Optimal or maximum acid inhibition in ulcer therapy? A decision guide for routine general practice based on personal...

The mucosal barrier in the stomach is complete only when the mucous layer has become saturated with bicarbonate. The latter arises as a waste product, as it were, of acid production in the parietal cell, but is then actively secreted via the surface epithelial cells and tight junctions. If the acid secretion is inhibited by means of drugs, the bicarbonate concentration also decreases. This situation probably occurs only when the bicarbonate batteries in the mucous layer and the surface epithelial cells have become "discharged" after a period of about 24 hours, which indicates an intermittent, non-maximum block. In the region between the surface epithelial cells and the mucous layer, Helicobacter pylori has its ecological niche. As studies with, for example, ranitidine nocte, amoxycillin and metronidazole have shown, a 12 hour alternation between acid secretion inhibition and the physiological buildup of the gastric mucosal barrier appears to promote the eradication of Helicobacter pylori. Hypotheses about the role of sudden ammonia production on the part of the pathogen and on the regulation of bicarbonate and acid production in humans underscore these findings.