Effect of splitting the dose of esomeprazole on gastric acidity and nocturnal acid breakthrough.
BACKGROUND
Twice-daily dosing is increasingly used to improve gastric acid control, although not all proton-pump inhibitors are more effective when doses are split. Standard dose esomeprazole provides better gastric acid control than other standard dose proton-pump inhibitors.


OBJECTIVE
To compare the effect of standard dose esomeprazole (1 x 40 mg) with 20 mg b.d. on gastric acidity.


METHODS
Thirteen healthy subjects participated in this crossover study, receiving esomeprazole 2 x 20 mg and 1 x 40 mg for 7 days in random order with a washout period of at least 7 days. Gastric 24-h pH was measured on days 1, 2 and 6.


RESULTS
Median gastric 24-h pH was higher during 2 x 20 mg esomeprazole on day 2 (P < 0.01), no differences were detected on day 6. Night-time gastric acid suppression was significantly improved by 2 x 20 mg esomeprazole on all study days (P < 0.05). Nocturnal acid breakthrough was observed on all study days in subjects receiving 1 x 40 mg, but in only 85% (first night), 64% (second night), and 45% of subjects (sixth night) with 2 x 20 mg (P < 0.05).


CONCLUSIONS
Splitting the esomeprazole dose improves initial acid suppression, this effect starts at the first night. Maximal benefit is achieved on day 2, while the effect on night-time acid control is detectable during the entire first week of treatment.
Hammer
J
J
Abteilung für Gastroenterologie und Hepatologie, Universitätsklinik für Innere Medizin IV, Währinger Gürtel 18-20, A-1090 Vienna, Austria. johann.hammer@univie.ac.at
Schmidt
B
B
D000328:Adult; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D002940:Circadian Rhythm; D064098:Esomeprazole / Q000008:administration & dosage*; D004947:Esophagus / Q000378:metabolism; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged
D000897:Anti-Ulcer Agents; D064098:Esomeprazole