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Esophageal acid exposure on proton pump inhibitors in unselected asymptomatic gastroesophageal reflux disease patients.
J Clin Gastroenterol. 2008 Oct; 42(9):969-73.JC

Abstract

BACKGROUND AND AIM

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+Show Affiliations

Dipartimento di Scienze Mediche, Cattedra di Gastroenterologia, Università degli Studi of Milan, Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18719508

Citation

Grigolon, Ausilia, et al. "Esophageal Acid Exposure On Proton Pump Inhibitors in Unselected Asymptomatic Gastroesophageal Reflux Disease Patients." Journal of Clinical Gastroenterology, vol. 42, no. 9, 2008, pp. 969-73.
Grigolon A, Cantù P, Savojardo D, et al. Esophageal acid exposure on proton pump inhibitors in unselected asymptomatic gastroesophageal reflux disease patients. J Clin Gastroenterol. 2008;42(9):969-73.
Grigolon, A., Cantù, P., Savojardo, D., Conte, D., & Penagini, R. (2008). Esophageal acid exposure on proton pump inhibitors in unselected asymptomatic gastroesophageal reflux disease patients. Journal of Clinical Gastroenterology, 42(9), 969-73. https://doi.org/10.1097/MCG.0b013e31814b8fc2
Grigolon A, et al. Esophageal Acid Exposure On Proton Pump Inhibitors in Unselected Asymptomatic Gastroesophageal Reflux Disease Patients. J Clin Gastroenterol. 2008;42(9):969-73. PubMed PMID: 18719508.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Esophageal acid exposure on proton pump inhibitors in unselected asymptomatic gastroesophageal reflux disease patients. AU - Grigolon,Ausilia, AU - Cantù,Paolo, AU - Savojardo,Daniela, AU - Conte,Dario, AU - Penagini,Roberto, PY - 2008/8/23/pubmed PY - 2008/12/17/medline PY - 2008/8/23/entrez SP - 969 EP - 73 JF - Journal of clinical gastroenterology JO - J Clin Gastroenterol VL - 42 IS - 9 N2 - BACKGROUND AND AIM: 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. SN - 1539-2031 UR - https://www.unboundmedicine.com/medline/citation/18719508/Esophageal_acid_exposure_on_proton_pump_inhibitors_in_unselected_asymptomatic_gastroesophageal_reflux_disease_patients_ L2 - https://doi.org/10.1097/MCG.0b013e31814b8fc2 DB - PRIME DP - Unbound Medicine ER -