title: Esophageal acid exposure on proton pump inhibitors in unselected asymptomatic gastroesophageal reflux disease patients.
abstract: 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.
authors: Dipartimento di Scienze Mediche, Cattedra di Gastroenterologia, Università degli Studi of Milan, Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
authors: Ausilia
authors: A
authors: Grigolon
authors: Paolo
authors: P
authors: Cantù
authors: Daniela
authors: D
authors: Savojardo
authors: Dario
authors: D
authors: Conte
authors: Roberto
authors: R
authors: Penagini
mesh_terms: 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
chemical_list: D054328:Proton Pump Inhibitors