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Omeprazole, Hypergastrinemia, and Gastric Carcinoid Tumors

James W. Freston, MD, PhD
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University of Connecticut Health Center; Farmington, CT 06030

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;121(3):232-233. doi:10.7326/0003-4819-121-3-199408010-00012
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The long-term management of reflux esophagitis is challenging because of the frequency of symptomatic relapses and the uncertain efficacy and safety of long-term treatment with acid-suppressing drugs. Reflux esophagitis recurs within 6 months in at least 80% of patients after discontinuation of medical therapy [1]. Thus, some patients, such as those described in this issue by Klinkenberg-Knol and colleagues [2], require continuous therapy with omeprazole. Despite its superior efficacy when compared with histamine-2-(H2) receptor antagonists in healing reflux esophagitis [3] and maintaining remissions [4], clinicians have generally been reluctant to treat patients chronically with omeprazole because of concerns about the long-term effects of omeprazole-induced hypergastrinemia. Omeprazole also is superior to H2-receptor antagonists in healing gastric and duodenal ulcers [3] and is effective in combination with amoxicillin in eradicating Helicobacter pylori infection [5], but the hypergastrinemia associated with such short-term use appears to be of little consequence.

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