Esophageal acid exposure on proton pump inhibitors in unselected asymptomatic gastroesophageal reflux disease patients.
OBJECTIVE
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.
Grigolon
Ausilia
A
Dipartimento di Scienze Mediche, Cattedra di Gastroenterologia, Università degli Studi of Milan, Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
Cantù
Paolo
P
Savojardo
Daniela
D
Conte
Dario
D
Penagini
Roberto
R
D000328:Adult; D000368:Aged; D004334:Drug Administration Schedule; D050782:Esophageal pH Monitoring; D004941:Esophagitis / Q000188:drug therapy / Q000209:etiology; D004947:Esophagus / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000503:physiopathology; D006356:Heartburn / Q000188:drug therapy / Q000209:etiology; D006551:Hernia, Hiatal / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D012074:Remission Induction
D054328:Proton Pump Inhibitors