Document Detail

Acid inhibition in GERD-how much is enough?
MedLine Citation:
PMID:  15180716     Owner:  NLM     Status:  MEDLINE    
Gastric acid plays a fundamental role in the development of mucosal injury and symptoms in gastro-esophageal reflux disease(GERD). In this issue of the Journal, Milkes et al report the inability of proton pump inhibitor (PPIs) therapy to "normalize" 24-hour intraesophageal pH parameters despite good symptom control. Twenty-five of fifty H. pylori negative patients with chronic uncomplicated GERD failed to normalize their pH parameters. Failure of esophageal acid control correlated with inadequate gastric acid inhibition. These findings are provocative and interesting but difficult to reconcile against a large body of evidence supporting the superior therapeutic efficacy of PPIs in symptom control, healing of esophagitis, and decreasing the rate of dilations in patients with GERD. No information is provided regarding the status of the esophageal mucosa in patients failing to achieve normalization of pH values. This raises the question about the clinical significance of this finding: i.e., does the lack of normalization of esophageal pH parameters correlate with esophageal epithelial damage (endoscopically visible injury) or complications of the disease? The patient population for this study was highly selected, thus the true prevalence of this observation for the large pool of patients with GERD remains unknown. Despite this and other limitations, the study will likely stimulate further research to examine ultimately how much acid inhibition-and for how long-is critical to the healing of GERD and to prevent the complications of the disease.
Sami R Achem
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Publication Detail:
Type:  Comment; Comparative Study; Editorial    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  99     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-06-07     Completed Date:  2004-08-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  997-9     Citation Subset:  IM    
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MeSH Terms
Anti-Ulcer Agents / therapeutic use
Follow-Up Studies
Gastric Acid / metabolism
Gastric Acidity Determination
Gastroesophageal Reflux / diagnosis*,  drug therapy*
Hydrogen-Ion Concentration*
Proton Pumps / adverse effects*,  therapeutic use
Risk Factors
Sensitivity and Specificity
Severity of Illness Index
Reg. No./Substance:
0/Anti-Ulcer Agents; 0/Proton Pumps
Comment On:
Am J Gastroenterol. 2004 Jun;99(6):991-6   [PMID:  15180715 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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