Nocturnal gastric acidity and acid breakthrough on different regimens of omeprazole 40 mg daily

Hatlebakk, Jan Gunnar; Katz, Philip O.; Kuo, Be-Sheng; Castell, Donald O.

doi:10.1046/j.1365-2036.1998.00426.x

Cited by 172 publications

(138 citation statements)

References 24 publications

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“…41 The maintenance of pH levels above pH ¼ 4 is considered to be the critical factor for the healing of severe ulcerative oesophagitis, 23 for the reduction of redilatation rates in patients with peptic oesophageal strictures 25 and for the prevention of the development of dysplasia and oesophageal adenocarcinoma in patients with Barrett's oesophagus. 42 However, the maintenance of pH levels above pH ¼ 4 during the night could involve dinner time administration 7,43,44 or fractionated dosing of proton pump inhibitors, 7,45 with a consequent increase in the complexity of treatment, or the addition of a bedtime H 2 -blocker in order to prevent nocturnal acid breakthrough. 46 The consequent increase in the cost and complexity of therapy with an additional dose of bedtime H 2 -blocker to proton pump inhibitors would only be justified if this treatment proved to be effective and if a close association between supine nocturnal oesophageal acid exposure and complicated reflux disease was demonstrated.…”

Section: Discussionmentioning

confidence: 99%

“…nocturnal recovery of gastric acid secretion, is a frequently occurring phenomenon during treatment with proton pump inhibitors, and has been advocated as a possible explanation for GERD patients with oesophageal mucosal lesions that remain refractory to treatment. 6,7 This explanation is based on the common belief that nocturnal oesophageal acid reflux is critically involved in the development of mucosal lesions in GERD: 7 acid reflux occurring at night in the recumbent position has the highest probability of damaging the oesophageal mucosa owing to the loss of drainage by gravity and to the absence of primary peristalsis and salivation during sleep. However, although some pH-metric studies support a critical role for nocturnal oesophageal acid exposure in the development of mucosal lesions in GERD, [8][9][10][11][12][13] others do not.…”

Section: Introductionmentioning

confidence: 99%

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Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Frazzoni

Micheli

Savarino

2003

Aliment Pharmacol Ther

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SummaryBackground : The reason why less than one‐half of patients with gastro‐oesophageal reflux disease develop complicated reflux disease (ulcerative oesophagitis, oesophageal strictures and Barrett's oesophagus) and erosive reflux oesophagitis is not fully understood. Supine nocturnal oesophageal acid reflux is considered to be critically involved in this phenomenon, but reliable data are lacking.Aim : To clarify whether high levels of supine nocturnal oesophageal acid exposure are associated with complicated reflux disease.Methods : Ambulatory 24‐h oesophageal pH monitoring was performed in 220 patients with gastro‐oesophageal reflux disease (56 with complicated reflux disease, 76 with erosive reflux oesophagitis and 88 with non‐erosive reflux disease). The total, supine nocturnal and upright diurnal percentage acid reflux times were calculated.Results : The total percentage acid reflux time was significantly greater in complicated reflux disease than in either erosive reflux oesophagitis (P = 0.024) or non‐erosive reflux disease (P = 0.000). These differences were entirely due to a greater supine nocturnal percentage acid reflux time (P = 0.038 and P = 0.000, respectively), whereas no difference was observed in the upright diurnal percentage acid reflux time.Conclusions : Complicated reflux disease is characterized by high levels of supine nocturnal percentage acid reflux time. Prospective studies would be appropriate to clarify whether the normalization of this parameter is relevant to the effective management of this subset of patients with gastro‐oesophageal reflux disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Frazzoni

Micheli

Savarino

2003

Aliment Pharmacol Ther

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“…Furthermore, fasting administration makes the peak plasma concentration match the maximum number of activated proton pump. In nocturnal GERD, it has been found that omeprazole administration before dinner reaches greater inhibitory levels than its administration before breakfast (83). Moreover, in patients with GERD administration twice daily is more effective than once, although it can hinder adherence.…”

Section: Tips To Optimize Ppi Treatmentmentioning

confidence: 99%

Practical considerations in the management of proton-pump inhibitors

Aguilera¹,

Martín-de-Argila-dePrados²,

Albillos-Martínez³

2015

Rev Esp Enferm Dig

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Proton-pump inhibitors (PPIs) are one of the most active ingredients prescribed in Spain. In recent decades there has been an overuse of these drugs in both outpatient clinics and hospitals that has lead to a significant increase in healthcare spending and to an increase in the risk of possible side effects. It is important for health professionals to know the accepted indications and the correct doses for the use of these drugs. On the market there are different types of PPI: omeprazole, pantoprazole, lansoprazole, rabeprazole and esomeprazole. Omeprazole is the oldest and most used PPI, being also the cheapest. Although there are no important differences between PPIs in curing diseases, esomeprazole, a newgeneration PPI, has proved to be more effective in eradicating H. pylori and in healing severe esophagitis compared to other PPIs. In recent years the use of generic drugs has spread; these drugs have the same bioavailability than the original drugs. In the case of PPIs, the few comparative studies available in the literature between original and generic drugs have shown no significant differences in clinical efficacy.Key words: Proton-pump inhibitor. PPI. Omeprazole. Pantoprazole. Lansoprazole. Rabeprazole. Esomeprazole. INTRODUCTIONProton-pump inhibitors (PPIs) represent a family of drugs widely used in our country. The advent in the nineties of PPIs was a great revolution in the treatment of ulcer disease and gastroesophageal reflux. The main problems of PPIs at present time are its overuse and the errors in the therapeutic indication. This fact leads to a considerable health economic cost and the risk of long-term side effects. In this review the main problems of PPIs prescription, their indications, the differences between PPIs and tips on their use are discussed. Brief historical memory: since alkaline diets until PPIsThe treatment of ulcer disease and gastroesophageal reflux disease (GERD) in the early twentieth century was the prescription of alkaline foods like milk, eggs and puree (1). Later, there were products as sodium bicarbonate that improved symptoms but did not prevent complications. Surgical treatment consisted of different types of gastric surgeries for peptic ulcer disease and Nissen fundoplication for GERD (2).In the mid twentieth century the use of muscarinic antagonists was introduced, atropine being its main active ingredient. Acids secretion was partially inhibited by blocking the muscarinic receptor of the parietal cell. However, these drugs had little effectiveness and numerous adverse effects due to the amount of muscarinic receptors distributed throughout the body. E-type prostaglandin was discovered later, but, again, the limitations of these substances were their short half life and side effects. An important progress in gastric antisecretory therapy was the appearance of H 2 receptors antagonists (H 2 blockers) (3). The most used were ranitidine and famotidine. These drugs established a substantial change by blocking the action of histamine receptor in gastric parietal ...

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“…Both methods may lead to further symptom improvement and both appear to be equally effective [33] . If a patient has predominantly nighttime symptoms, more effective nocturnal acid suppression may be achieved with bid or nighttime dosing of PPIs [34] . Another approach in the PPI-refractory patient involves the addition of nighttime H2RAs to bid PPI therapy for persistent nighttime symptoms.…”

Section: Lifestyle Changesmentioning

confidence: 99%

Diagnosis and Treatment of Gastroesophageal Reflux Disease

Vaezi¹

2016

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Gastroesophageal reflux disease (GERD) is a common disease with a prevalence as high as 10%-20% in the western world. The disease can manifest in various symptoms which can be grouped into typical, atypical and extra-esophageal symptoms. Those with the highest specificity for GERD are acid regurgitation and heartburn. In the absence of alarm symptoms, these symptoms can allow one to make a presumptive diagnosis and initiate empiric therapy. In certain situations, further diagnostic testing is needed to confirm the diagnosis as well as to assess for complications or alternate causes for the symptoms. GERD complications include erosive esophagitis, peptic stricture, Barrett's esophagus, esophageal adenocarcinoma and pulmonary disease. Management of GERD may involve lifestyle modification, medical therapy and surgical therapy. Lifestyle modifications including weight loss and/or head of bed elevation have been shown to improve esophageal pH and/or GERD symptoms. Medical therapy involves acid suppression which can be achieved with antacids, histamine-receptor antagonists or proton-pump inhibitors. Whereas most patients can be effectively managed with medical therapy, others may go on to require antireflux surgery after undergoing a proper pre-operative evaluation. The purpose of this review is to discuss the current approach to the diagnosis and treatment of gastroesophageal reflux disease.

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Nocturnal gastric acidity and acid breakthrough on different regimens of omeprazole 40 mg daily

Cited by 172 publications

References 24 publications

Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non‐erosive reflux disease

Practical considerations in the management of proton-pump inhibitors

Diagnosis and Treatment of Gastroesophageal Reflux Disease

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