Acid suppression and gastric atrophy: sifting fact from fiction

Prolonged pharmacological acid suppression is associated with various histological changes in the gastric mucosa, particularly in Helicobacter pylori infected patients. In a number of subjects these changes include a shift in the gastric inflammation from the antrum to the corpus. This finding has been interpreted as gastric atrophy, and the possibility that acid suppression accelerates the progress of lesions that may lead to gastric cancer has been considered. Two recent studies on the relation between treatment with proton pump inhibitors and atrophic gastritis have yielded apparently contradictory results. These studies are reviewed in detail here and some of the possible reasons for the discrepant conclusions are explored. In particular, the way the terms "gastric atrophy" and "atrophic gastritis" are used is examined critically.