Document Detail

Esophageal acid exposure on proton pump inhibitors in unselected asymptomatic gastroesophageal reflux disease patients.
MedLine Citation:
PMID:  18719508     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIM: Efficacy of proton pump inhibitors (PPIs) on symptoms of gastroesophageal reflux (GER) is supposed to result from normalization of esophageal acid exposure; however, recent data in selected severe patients have challenged this concept. The aim of the study was to investigate 24-hour esophagogastric pH in unselected patients with GER disease in symptomatic remission during PPIs. METHODS: Thirty of the 31 consecutive patients with heartburn enrolled achieved adequate symptom control (<or=1 heartburn episode/wk) on PPIs o.d. (n=22) or b.d. (n=8); 3 refused pH monitoring, thus 27 tracings were analyzed. RESULTS: Medians (Interquartile Range); Intragastric tracings showed a wide range of inhibition of acid secretion, 61.2% (49.7% to 80.2%) time at pH>4, nocturnal acid breakthrough being shorter (P=0.03) on PPIs b.d. compared with PPIs o.d., 125 minutes (90 to 247) versus 253 minutes (210 to 340). Esophageal acid exposure was 3.3% (1.4% to 7.9%) time at pH<4, 9 patients having increased exposure (ie, >5.5%), 7 of whom on PPIs o.d. Patients with increased acid GER on PPIs had a higher prevalence of esophagitis (67% vs. 22%, P<0.05) and hiatus hernia (78% vs. 39%, P<0.1) at endoscopy off PPIs. CONCLUSIONS: One third of unselected patients with GER disease asymptomatic on PPIs have an increased esophageal acid exposure, especially if their PPI is administered o.d.
Ausilia Grigolon; Paolo Cantù; Daniela Savojardo; Dario Conte; Roberto Penagini
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of clinical gastroenterology     Volume:  42     ISSN:  1539-2031     ISO Abbreviation:  J. Clin. Gastroenterol.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-22     Completed Date:  2008-11-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7910017     Medline TA:  J Clin Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  969-73     Citation Subset:  IM    
Dipartimento di Scienze Mediche, Cattedra di Gastroenterologia, Università degli Studi of Milan, Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
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MeSH Terms
Drug Administration Schedule
Esophageal pH Monitoring
Esophagitis / drug therapy,  etiology
Esophagus / drug effects*,  physiopathology
Gastroesophageal Reflux / drug therapy*,  physiopathology
Heartburn / drug therapy,  etiology
Hernia, Hiatal / drug therapy,  etiology
Hydrogen-Ion Concentration
Middle Aged
Prospective Studies
Proton Pump Inhibitors / administration & dosage,  pharmacology*
Remission Induction
Reg. No./Substance:
0/Proton Pump Inhibitors

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