Esophageal acid exposure on proton pump inhibitors in unselected asymptomatic gastroesophageal reflux disease patients

Journal of Clinical Gastroenterology
Ausilia GrigolonRoberto Penagini

Abstract

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. 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. 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. One third of unselected patients with GER disease asymptomat...Continue Reading

References

Jul 16, 1999·The American Journal of Gastroenterology·T HavelundO Anker-Hansen
May 7, 2002·Scandinavian Journal of Gastroenterology·R PenaginiP A Bianchi
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Apr 22, 2006·Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver·M FrazzoniV Savarino

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Citations

Dec 4, 2010·Best Practice & Research. Clinical Gastroenterology·Stanislas Bruley des VarannesJean-Paul Galmiche
Aug 26, 2010·The American Journal of Gastroenterology·Philipp KirchhoffJohn P Geibel
May 7, 2009·Current Opinion in Gastroenterology·Yuhong Yuan, Richard H Hunt

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