title: High-dose esomeprazole is required for intraesophageal acid control in gastroesophageal reflux disease patients with hiatus hernia.
abstract: OBJECTIVE
  The aim of this study was to assess whether the efficacy of proton pump inhibitors (PPI) therapy at a standard dose in esophageal acid control is affected by the presence of hiatus hernia in Chinese gastroesophageal reflux disease patients, and whether a higher dose of PPI is required for acid control.
  
  
  METHODS
  Consecutive gastroesophageal reflux disease patients who had typical reflux symptoms and abnormal baseline 24-h esophageal pH and underwent upper endoscopy were enrolled to receive esomeprazole at 40 mg once daily for 4 weeks. Patients underwent the dual-channel 24-h pH test at the end of 4-week therapy. If the 24-h esophageal pH was still abnormal at the end of 4-week therapy, then esomeprazole at 40 mg twice daily was given for another 4 weeks after a washout interval of 1 week, and a 24-h pH test was repeated at the end of the therapy.
  
  
  RESULTS
  Overall, 76 patients were included, 13 with hiatus hernia. Of the 76 patients treated with a 40 mg of esomeprazole daily, esophageal acid exposure was normalized in 64 (84.2%). Normalization of acid exposure was achieved by standard PPI therapy in 53.2% (7/13) of patients with hiatus hernia and 90.5% (57/63) of those without (P = 0.004). A double dose of esomeprazole was successful in normalizing the esophageal pH in all 12 non-responders to the standard dose of esomeprazole, including the six patients with hiatus hernia and six patients without.
  
  
  CONCLUSIONS
  The standard-dose of esomeprazole fails to normalize the esophageal pH in almost 50% of patients with hiatus hernia, in whom the "double-dose" esomeprazole therapy is required.
authors.affiliation: Division of Gastroenterology & Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Sui
authors.initials: S
authors.lastname: Peng
authors.forename: Ying-Lian
authors.initials: YL
authors.lastname: Xiao
authors.forename: Yi
authors.initials: Y
authors.lastname: Cui
authors.forename: Jin-Kun
authors.initials: JK
authors.lastname: Lin
authors.forename: Ning
authors.initials: N
authors.lastname: Zhang
authors.forename: Pin-Jin
authors.initials: PJ
authors.lastname: Hu
authors.forename: Min-Hu
authors.initials: MH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D016009:Chi-Square Distribution; D002681:China; D064098:Esomeprazole / Q000008:administration & dosage*; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy*; D005773:Gastroscopy; D006551:Hernia, Hiatal / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D018709:Statistics, Nonparametric; D013997:Time Factors
chemical_list: D054328:Proton Pump Inhibitors; D064098:Esomeprazole