Helicobacter pylori infection influences nocturnal gastric acid breakthrough

Abstract

Background: Nocturnal gastric acid breakthrough is defined as night‐time periods when gastrin pH falls below 4.0 for greater than 1h during administration of a proton pump inhibitor. This phenomenon is a serious problem for patients who require strict control of their gastric acid secretions. Aim: To investigate the prevalence of nocturnal gastric acid breakthrough in Japanese subjects during administration of rabeprazole, and to clarify the relationship between Helicobacter pylori infection and nocturnal gastric acid breakthrough. Methods: Thirty‐one normal male volunteers were examined by ambulatory 24 h gastric pH monitoring four times: without medication, after a morning or an evening dose of 20 mg rabeprazole, and after administration of an H2‐receptor antagonist at bedtime, in addition to the morning dose of rabeprazole. H. pylori infection was determined by the 13C‐urea breath test and an assay for serum anti‐H. pylori antibody. Result: Nocturnal gastric acid breakthrough was observed in 12 patients (39%) after the morning dose of 20 mg rabeprazole. In all cases, nocturnal gastric acid breakthrough was inhibited completely by administration of the H2‐receptor antagonist at bedtime. Only one patient with nocturnal gastric acid breakthrough had H. pylori infection. Conclusion: The absence of H. pylori infection appears to be closely related to the occurrence of nocturnal gastric acid breakthrough during dosing with a proton pump inhibitor.

Effect of omeprazole 10 mg on intragastric pH in three different CYP2C19 genotypes, compared with omeprazole 20 mg and lafutidine 20 mg, a new H2‐receptor antagonist

“…It was not prevented by an increase in the dose of omeprazole, and occurred in all CYP2C19 genotypes, as previously reported. 33,40 With lafutidine, the intragastric pH increased in the daytime as well as at night. 25 In the night-time period with lafutidine 20 mg, the median pH values and pH > 4HTs were 3.0 and 40% in the homo-EMs, 2.7 and 28% in the hetero-EMs, and 2.9 and 35% in the PMs, respectively, which are similar to conventional H 2 -RAs.…”

New method for long-term monitoring of intragastric pH

“…However, they have some clinical weaknesses, tachyphylaxis and nocturnal gastric acid breakthrough [28][29][30] , which have not been resolved. One reason has been the availability of only intermittent pH monitoring, but not long-term continuous monitoring.…”

Review: Causes of, and therapeutic approaches for, proton pump inhibitor-resistant gastroesophageal reflux disease in Asia

“…Therefore, in those cases PPIs are potent enough for treatment of any type of acid-related disease, including GERD. In the absence of H. pylori, PPIs are not potent enough to raise nocturnal intragastric pH, though they can increase intragastric pH to neutral during the postprandial daytime period Katsube et al 2000]. Long-lasting (usually more than 1 h) nocturnal intragastric acidification even during PPI administration is called 'nocturnal gastric acid breakthrough' and often observed in cases not infected by H. pylori.…”