Long-term PPI effects analyzedGastric atrophy and intestinal metaplasia in a patient on long-term proton pump inhibitor therapy.
Combination therapy complicates results
We explored the case of a 74-year-old man who had been taking proton pump inhibitors for 20 years to manage symptoms of gastroesophageal reflux disease. Despite stopping his acid-reducing medications for a month, he showed an unusually high gastric pH level, indicating a significant decrease in stomach acidity. This condition may have led to gastric atrophy and intestinal metaplasia, as revealed through multiple biopsies of his stomach lining. Interestingly, after halting all anti-secretory drugs and starting only prokinetic treatment, the patient reported a significant improvement in heartburn symptoms.
During follow-up, although he developed symptoms of peripheral neuropathy—which were found to be related to a low level of vitamin B12—prompt treatment with vitamin B12 injections alleviated this issue. However, the correlation between improved heartburn symptoms and the vitamin B12 therapy is difficult to establish because the patient was also on prokinetics, which could have contributed to his symptom relief. Overall, our findings indicate that while vitamin B12 treatment offered benefits in this case, isolating its specific effect on heartburn remains challenging due to the combination therapy involved.
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