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Table 3 Summary of key effects of acid suppressing agents in relation to multiple sclerosis

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

Agent Response
H2R antagonists No reports of acute worsening of MS disease status
Increases EAE incidence
Promotes Th1 and Th17 responses
Promotes production of proinflammatory cytokines
Promotes T cell response, for example, proliferation
Promotes suppression of Th2 response
Block suppression of dendritic cells
PPIs No reports of acute worsening of MS disease status
Not studied in EAE
Suppresses reactive oxygen species
Lessens expression of adhesion molecules
Suppresses production of proinflammatory cytokines
Increased gastric pH
(H2R antagonists, PPIs, or antacids)
No reports of acute worsening of MS disease status
Possibly alters microflora in the stomach and small intestine
Possibly alters neutrophil response
Can lead to vitamin B12 deficiency
  1. EAE: experimental autoimmune encephalomyelitis; H2R: histamine receptor-2; MS: multiple sclerosis; PPI: proton pump inhibitor; Th: T helper cell.