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Physiologic, pathophysiologic, and pharmacologic regulation of gastric acid secretion

Schubert, Mitchell L.a,b

Current Opinion in Gastroenterology: November 2017 - Volume 33 - Issue 6 - p 430–438
doi: 10.1097/MOG.0000000000000392
STOMACH AND DUODENUM: Edited by Mitchell L. Schubert
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Purpose of review The present review summarizes the past year's literature, both clinical and basic science, regarding physiologic and pharmacologic regulation of gastric acid secretion in health and disease.

Recent findings Gastric acid kills microorganisms, assists digestion, and facilitates absorption of iron, calcium, and vitamin B12. The main stimulants of acid secretion are the hormone gastrin, released from antral G cells; paracrine agent histamine, released from oxyntic enterochromaffin-like cells; and neuropeptide acetylcholine, released from antral and oxyntic intramural neurons. Gastrin is also a trophic hormone that participates in carcinogenesis. Helicobacter pylori may increase or decrease acid secretion depending upon the acuity and predominant anatomic focus of infection; most patients manifest hypochlorhydria. Despite the fact that proton pump inhibitors (PPIs) are amongst the most widely prescribed drugs, they are underutilized in patients at high risk for UGI bleeding. Although generally considered well tolerated, concerns have been raised regarding associations between PPI use and dementia, kidney disease, myocardial infarction, pneumonia, osteoporosis, dysbiosis, small bowel injury, micronutrient deficiency, and fundic gland polyps.

Summary Our understanding of the physiologic, pathophysiologic, and pharmacologic regulation of gastric secretion continues to advance. Such knowledge is crucial for improved and safe management of acid-peptic disorders.

aDepartment of Medicine, Division of Gastroenterology, Virginia Commonwealth University Health System

bGastroenterology Section, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA

Correspondence to Mitchell L. Schubert, MD, Gastroenterology Section, Hunter Holmes McGuire Veterans Affairs Medical Center, Code 111N, 1201 Broad Rock Blvd, Richmond, VA 23249, USA. Tel: +1 804 675 5021; fax: +1 804 675 5816; e-mail: Mitchell.Schubert@va.gov

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