Potential immunological consequences of pharmacological suppression of gastric acid production in patients with multiple sclerosis

Abstract

Corticosteroids are standard treatment for patients with multiple sclerosis experiencing acute relapse. Because dyspeptic pain is a common side effect of this intervention, patients can be given a histamine receptor-2 antagonist, proton pump inhibitor or antacid to prevent or ameliorate this disturbance. Additionally, patients with multiple sclerosis may be taking these medications independent of corticosteroid treatment. Interventions for gastric disturbances can influence the activation state of the immune system, a principal mediator of pathology in multiple sclerosis. Although histamine release promotes inflammation, activation of the histamine receptor-2 can suppress a proinflammatory immune response, and blocking histamine receptor-2 with an antagonist could shift the balance more towards immune stimulation. Studies utilizing an animal model of multiple sclerosis indicate that histamine receptor-2 antagonists potentially augment disease activity in patients with multiple sclerosis. In contrast, proton pump inhibitors appear to favor immune suppression, but have not been studied in models of multiple sclerosis. Antacids, histamine receptor-2 antagonists and proton pump inhibitors also could alter the intestinal microflora, which may indirectly lead to immune stimulation. Additionally, elevated gastric pH can promote the vitamin B12 deficiency that patients with multiple sclerosis are at risk of developing. Here, we review possible roles of gastric acid inhibitors on immunopathogenic mechanisms associated with multiple sclerosis.

Acid suppression therapy and allergic reactions

“…Furthermore, it was proposed that H2 receptor activation might shi the immune response towards 2 dominance. us, it is not surprising that H2 receptor antagonists have an eminent e ect on the immune response with an overall immune-activating potential as reviewed by Biswas and colleagues [54]. In context with the above mentioned ndings, it is of special interest that usage of H2 receptor antagonists in in ammatory bowel disease patients was reported to increase the risk for hospitalization [55].…”

Integrated analysis of concomitant medications and oncological outcomes from PD-1/PD-L1 checkpoint inhibitors in clinical practice

“… 59 Gastric acid suppressants can cause immune-suppressive effects through the inhibition of adhesion molecules of inflammatory cells and affecting cytokines secretion. 60 Aspirin can exert several effects on both innate and adaptive immune responses. It can modulate proliferation/maturation of immune cells, regulate the cytokine production, and induce the lipoxin-driven immune counter-regulation.…”

Vitamin B12 Intake Correlated to Physical and Mental Improvements in Multiple Sclerosis Specific Quality of Life

“…Reductions in serum vitamin B 12 levels in individuals with MS treated with Copaxone and Interferon-h have been noted and attributed partially to the drug's role in enhancing the need for vitamin B 12 for myelin repair [11]. Another common drug therapy prescribed to individuals with MS that may influence vitamin B 12 status are corticosteroids and are often used for individuals experiencing an acute relapse [40]. This approach has been observed, in high doses, to lead to a decrease in both cerebral spinal fluid (CSF) and serum levels of vitamin B 12 [41].…”

“…This approach has been observed, in high doses, to lead to a decrease in both cerebral spinal fluid (CSF) and serum levels of vitamin B 12 [41]. Often used in conjunction with corticosteroid treatment are medications such as histamine receptor-2 (H2R) antagonist, proton pump inhibitor (PPI) or antacid to combat the prevalent dyspeptic pain associated with corticosteroids [40]. Despite which drug therapy is used to treat this side effect, the goal is to raise the gastric pH either directly or indirectly.…”