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Review article: the control of gastric acid and Helicobacter pylori eradication Sachs G; Shin JM; Munson K; Vagin O; Lambrecht N; Scott DR; Weeks DL; Melchers KAliment Pharmacol Ther 2000[Nov]; 14 (11): 1383-401This review focuses on the gastric acid pump as a therapeutic target for the control of acid secretion in peptic ulcer and gastro-oesophageal reflux disease. The mechanism of the proton pump inhibitors is discussed as well as their clinical use. The biology of Helicobacter pylori as a gastric denizen is then discussed, with special regard to its mechanisms of acid resistance. Here the properties of the products of the urease gene clusters, ureA, B and ureI, E, F, G and H are explored in order to explain the unique location of this pathogen. The dominant requirement for acid resistance is the presence of a proton gated urea transporter, UreI, which increases access of gastric juice urea to the intrabacterial urease 300-fold. This enables rapid and continuous buffering of the bacterial periplasm to approximately pH 6.0, allowing acid resistance and growth at acidic pH in the presence of 1 mM urea. A hypothesis for the basis of combination therapy for eradication is also presented.|*Proton Pump Inhibitors[MESH]|Gastric Acid/*metabolism[MESH]|H(+)-K(+)-Exchanging ATPase/drug effects/physiology[MESH]|Helicobacter Infections/*drug therapy[MESH]|Helicobacter pylori/*drug effects[MESH]|Humans[MESH]|Hydrogen-Ion Concentration[MESH]|Peptic Ulcer/*drug therapy/microbiology[MESH]|Urease/*genetics/physiology[MESH] |
