Review

Do We Need Gastric Acid?
D. Pohl^a, M. Fox^a, M. Fried^a, B. Göke^b, C. Prinz^c, H. Mönnikes^d, G. Rogler^a, M. Dauer^b, J. Keller^e, F. Lippl^b, I. Schiefke^f, U. Seidler^g, H.D. Allescher^h, on behalf of the Kandahar Study Group

^aDivision of Gastroenterology, Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland;
^bSection of Gastroenterology, Department of Internal Medicine, Campus Innenstadt und Grohadern, University of Munich, and
^cMedical Department, Technical University of Munich, Munich,
^dDivision of Hepatology, Gastroenterology, and Endocrinology, Department of Medicine, Charité Medical Center, Campus Virchow, Humboldt University, Berlin,
^eDepartment of Internal Medicine, Israelitic Hospital, Hamburg,
^fDepartment of Internal Medicine, University Hospital Leipzig, Leipzig,
^gDepartment of Gastroenterology and Hepatology, Medizinische Hochschule Hannover, Hannover, and
^hCenter for Internal Medicine, Gastroenterology, Hepatology and Metabolism, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany

Address of Corresponding Author

Digestion 2008;77:184-197 (DOI: 10.1159/000142726)

  Key Words

• Gastric acid secretion
• Gastric emptying
• Gastric motility
• Helicobacter pylori
• Clostridium difficile
• Proton pump inhibitors
• Acid suppression
• Metabolism, neuroendocrine
• Ghrelin
• Satiety

  Abstract

Evidence from comparative anatomy and physiology studies indicates that gastric acid secretion developed during the evolution of vertebrates approximately 350 million years ago. The cellular mechanisms that produce gastric acid have been conserved over the millennia and therefore proton pump inhibitors have pharmacological effects in almost all relevant species. These observations suggest that gastric acid provides an important selective advantage; however, in modern-day humans the need for gastric acid can be questioned in light of the widespread use of safe and effective pharmacologic acid suppression. The Kandahar Working Group addressed questions concerning the need, production and effects of gastric acid, specifically: (1) motility in the upper gastrointestinal (GI) tract; (2) neuroendocrine factors; (3) digestive and mucosal processes; (4) microbiology, and (5) central processes and psychological involvement. We addressed each topic with the individual models available to answer our questions including animal versus human studies, pharmacologic, surgical as well as pathophysiologic states of acid suppression.

Copyright © 2008 S. Karger AG, Basel

  Author Contacts

Daniel Pohl, MD
Division of Gastroenterology and Hepatology
Department of Internal Medicine, University Hospital Zurich
Raemistr. 100, CH-8091 Zurich (Switzerland)
Tel. +41 44 255 1111, Fax +41 44 255 4591, E-Mail daniel.pohl@usz.ch

  Article Information

This review is based on the proceedings of the Kandahar Workshop, 22-25 June 2006, Grainau, Germany. The meeting was supported by an unrestricted educational grant by Altana-Nycomed.

Published online: July 2, 2008
Number of Print Pages : 14
Number of Figures : 0, Number of Tables : 0, Number of References : 191