Gastric cancer, proton pump inhibitors

Less common causes of peptic ulceration include Zollinger-Ellison syndrome (ZES), cancer chemotherapy, radiation, and vascular insufficiency. ZES is caused by a gastrin-producing tumor called a gastrinoma and results in gastric acid hypersecretion. High-dose oral proton pump inhibitor (PPI) therapy is the initial treatment of choice for ZES intermittent intravenous PPI therapy may be required for any patient in whom oral therapy is contraindicated.1... 

Proton pump inhibitors such as omeprazole may mask the symptoms of gastric cancer. Omeprazole is best avoided during breast-feeding. The prescription is indicative of triple therapy used as eradication therapy in H. pylori infection. 

Anti-secretory treatment, by reducing the acid barrier to infection approximately doubles the risk of infective diarrhoea. Fears that treatment like H2 receptor antagonists or proton pump inhibitors would increase the risk of gastric cancer have not been realised. Raised frequencies of oesophageal cancer in patients taking proton pump inhibitors reflect underlying predisposition in Barrett s disease. 

Answer Peptic ulcer disease is most frequently secondary to either Helicobacter pylori infection or use of NSAIDs. The patient does admit to NSAID use (naproxen), but should also be checked for concomitant H. pylori infection at time of endoscopy or by a serology test. If the patient was found to have H. pylori, an appropriate eradication regimen should be prescribed. The patient should also be counseled to avoid NSAIDs. The patient should be prescribed a proton pump inhibitor for 8 weeks to heal the ulcer. A repeat endoscopy should be done at that time to document ulcer healing and rule out gastric cancer. In addition, the patient should be counseled to stop smoking, which is a risk factor for more severe peptic ulcer disease. 

There has been concern about the potential for proton pump inhibitors to cause enterochromaffin-hke cell hyperplasia, gastric carcinoid tumors and gastric cancers, colorectal polyps and adenocarcinoma, atrophic gastritis, and intestinal metaplasia in patients with H. pylori infection, and bacterial overgrowth. 

H. pylori is a major etiological factor in gastroduodenal disorders such as chronic gastritis, peptic ulcer, and gastric cancer. Therefore, the treatment and prevention of these diseases would be facilitated by its eradication. At present, triple therapies that comprise two antibiotics (clarithromycin and amphotericin B) and a proton pump inhibitor are used to eradicate H. pylori. However, strains that are resistant to antibiotics have appeared. In addition, antibiotic treatment is associated with serious side effects such as nausea, vomiting, and diarrhea. Therefore, the discovery of novel antibacterial agents that are highly effective and safe is badly needed for the treatment of H. pylori infection. 

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