Digestive Diseases and Sciences

, Volume 40, Supplement 2, pp 81S–95S

Effects of acid suppression on microbial flora of upper gut

  • Neville D. Yeomans
  • Roger W. Brimblecombe
  • James Elder
  • Richard V. Heatley
  • J. J. Misiewicz
  • Timothy C. Northfield
  • Anthony Pottage
Article

DOI: 10.1007/BF02214873

Cite this article as:
Yeomans, N.D., Brimblecombe, R.W., Elder, J. et al. Digest Dis Sci (1995) 40(Suppl 2): 81S. doi:10.1007/BF02214873

Abstract

Decreased acid secretion, due to therapy or disease, predisposes to increased bacterial counts in gastric juice. As bacterial numbers increase, the number of nitrate-reducing strains and the concentration of luminal nitrite usually also increase. However, there is controversy (mainly because of assay problems) about whether decreased acid increases generation ofN-nitroso compounds: these may be produced by acid or by bacterial catalysis, and the relative contributions of each are still uncertain. Other potentially important factors include ascorbate secretion (can prevent nitrite conversion to nitroso compounds) and the particular spectrum of nitroso compounds produced. Nitrosation of several histamine H2-receptor antagonists has been demonstrated experimentally, but under conditions that are very unlikely to be encountered clinically. Some acid suppressant therapies have been claimed to aid eradication ofHelicobacter pylori, but more work is needed to evaluate this. If ulcer treatment regimens do not also address eradication ofH. pylori (when present), gastritis will progress, and the recently documented association betweenH. pylori and gastric carcinoma needs to be considered. Enteric flora probably also increase if acid secretion is markedly reduced: this does not appear to have nutritional consequences but probably reduces the resistance to occasional infections, of which cholera is the best documented.

Key Words

bacteriaN-nitroso compoundsHelicobacter pylorigastric neoplasmsgastric surgerygastritis histamine H2-receptor antagonistsacid-pump blockersintestinal infections

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Neville D. Yeomans
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • Roger W. Brimblecombe
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • James Elder
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • Richard V. Heatley
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • J. J. Misiewicz
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • Timothy C. Northfield
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • Anthony Pottage
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  1. 1.University of Melbourne Department of MedicineWestern HospitalMelbourneAustralia
  2. 2.Vanguard Medica LtdUK
  3. 3.Department of SurgeryUniversity of KeeleStoke-on-TrentUK
  4. 4.Department of MedicineSt James's HospitalLeedsUK
  5. 5.Department of Gastroenterology and NutritionCentral Middlesex HospitalLondonUK
  6. 6.Division of Biochemical MedicineSt George's HospitalLondonUK
  7. 7.Astra Clinical Research UnitEdinburghUK
  8. 8.Department of MedicineWestern HospitalFootscrayAustralia