title: Prevention of relapse of healed reflux esophagitis is related to the duration of intragastric pH > 4.
abstract: Proton pump inhibitors (PPIs) are the preferred treatment for maintenance of healed reflux esophagitis (RE). However, little is known regarding the relationship between prevention of RE relapse and degree of gastric acid suppression. The aim of this review was to examine this relationship in further detail. Data from four comparative studies on maintenance PPI therapy for prevention of relapse of RE were combined with data from two pharmacodynamic studies of duration of intragastric pH >4 during the 24-hour period on day 5 of PPI dosing in healthy subjects. A log-linear model was fitted to the data using the method of maximum likelihood. Variability in relapse rates and pH data was taken into account using a binomial and normal likelihood function, respectively. Pharmacodynamic studies resulted in a wide range of acid-suppressive effect, and based on corresponding maintenance of RE healing rates with different PPIs and doses, an inverse (non-linear) statistically significant relationship between percentage of time with pH >4 and maintenance of RE healing was identified (P<0.001). These findings indicate that long-term maintenance of healed RE is related to the extent of acid suppression in a 24-hour period.
authors.affiliation: Eastern Virginia Medical School, Norfolk, VA 23502, USA. dajevms@aol.com
authors.forename: David A
authors.initials: DA
authors.lastname: Johnson
authors.forename: Philip O
authors.initials: PO
authors.lastname: Katz
authors.forename: Doug
authors.initials: D
authors.lastname: Levine
authors.forename: Kerstin
authors.initials: K
authors.lastname: Röhss
authors.forename: Magnus
authors.initials: M
authors.lastname: Astrand
authors.forename: Ola
authors.initials: O
authors.lastname: Junghard
authors.forename: Péter
authors.initials: P
authors.lastname: Nagy
mesh_terms: D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D004942:Esophagitis, Peptic / Q000188:drug therapy* / Q000517:prevention & control; D005744:Gastric Acid / Q000378:metabolism*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016013:Likelihood Functions; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D055502:Secondary Prevention; D013997:Time Factors
chemical_list: D054328:Proton Pump Inhibitors