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Effects of omeprazole on mechanisms of gastroesophageal reflux in childhood.
Dig Dis Sci. 1997 Feb; 42(2):293-9.DD

Abstract

Prolonged recordings of esophageal motility have shown that dynamic changes of lower esophageal sphincter (LES) pressure such as transient LES relaxation and LES pressure drifts are the most common mechanisms underlying gastroesophageal reflux (GER). The coexistence of a delayed gastric emptying has also been reported in a high proportion of patients with reflux disease. However, not much information is available on the effects of antireflux therapy on the pathogenetic mechanisms of GER. The purpose of this study was to determine in a group of children with severe reflux disease the effect of omeprazole therapy on motor changes of LES underlying GER as well as on gastric emptying time. Twenty-two children (median age: 6.6 years) with GER disease, refractory to combined ranitidine and cisapride administration, entered into an eight-week omeprazole course. Ten subjects with moderate GER disease served as controls (median age: 6.0 years). Before and after omeprazole administration, the following variables were assessed: esophagitis grading, fasting and fed simultaneous prolonged recording of distal esophageal sphincter pressure (with a sleeve catheter) and intraesophageal pH, LES and esophageal peristalsis amplitude, and gastric emptying time of a mixed solid-liquid meal (measured with gastric ultrasound). As compared to controls, patients showed a higher rate of transient LES relaxation and LES pressure drift (P < 0.01), a reduced amplitude of basal sphincter pressure (P < 0.01) and peristalsis (P < 0.05), and a more prolonged gastric emptying time (P < 0.05). After ending omeprazole, there was no significant change in any of the motor abnormalities of the esophagus and in gastric emptying time despite a marked improvement of symptoms and esophagitis in all patients. Sixteen patients were symptomatic when reevaluated on a clinical basis two months after ending therapy. We conclude that in children with severe GER disease, an abnormally high rate of both transient LES relaxation and LES pressure drift and slow gastric emptying are not affected by omperazole treatment, even though esophageal mucosal damage is markedly improved or cured. These abnormalities represent a primary motor disorder and can be implicated in the refractoriness of reflux disease.

Authors+Show Affiliations

Department of Pediatrics, University of Naples Federico II, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

9052509

Citation

Cucchiara, S, et al. "Effects of Omeprazole On Mechanisms of Gastroesophageal Reflux in Childhood." Digestive Diseases and Sciences, vol. 42, no. 2, 1997, pp. 293-9.
Cucchiara S, Minella R, Campanozzi A, et al. Effects of omeprazole on mechanisms of gastroesophageal reflux in childhood. Dig Dis Sci. 1997;42(2):293-9.
Cucchiara, S., Minella, R., Campanozzi, A., Salvia, G., Borrelli, O., Ciccimarra, E., & Emiliano, M. (1997). Effects of omeprazole on mechanisms of gastroesophageal reflux in childhood. Digestive Diseases and Sciences, 42(2), 293-9.
Cucchiara S, et al. Effects of Omeprazole On Mechanisms of Gastroesophageal Reflux in Childhood. Dig Dis Sci. 1997;42(2):293-9. PubMed PMID: 9052509.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of omeprazole on mechanisms of gastroesophageal reflux in childhood. AU - Cucchiara,S, AU - Minella,R, AU - Campanozzi,A, AU - Salvia,G, AU - Borrelli,O, AU - Ciccimarra,E, AU - Emiliano,M, PY - 1997/2/1/pubmed PY - 1997/2/1/medline PY - 1997/2/1/entrez SP - 293 EP - 9 JF - Digestive diseases and sciences JO - Dig. Dis. Sci. VL - 42 IS - 2 N2 - Prolonged recordings of esophageal motility have shown that dynamic changes of lower esophageal sphincter (LES) pressure such as transient LES relaxation and LES pressure drifts are the most common mechanisms underlying gastroesophageal reflux (GER). The coexistence of a delayed gastric emptying has also been reported in a high proportion of patients with reflux disease. However, not much information is available on the effects of antireflux therapy on the pathogenetic mechanisms of GER. The purpose of this study was to determine in a group of children with severe reflux disease the effect of omeprazole therapy on motor changes of LES underlying GER as well as on gastric emptying time. Twenty-two children (median age: 6.6 years) with GER disease, refractory to combined ranitidine and cisapride administration, entered into an eight-week omeprazole course. Ten subjects with moderate GER disease served as controls (median age: 6.0 years). Before and after omeprazole administration, the following variables were assessed: esophagitis grading, fasting and fed simultaneous prolonged recording of distal esophageal sphincter pressure (with a sleeve catheter) and intraesophageal pH, LES and esophageal peristalsis amplitude, and gastric emptying time of a mixed solid-liquid meal (measured with gastric ultrasound). As compared to controls, patients showed a higher rate of transient LES relaxation and LES pressure drift (P < 0.01), a reduced amplitude of basal sphincter pressure (P < 0.01) and peristalsis (P < 0.05), and a more prolonged gastric emptying time (P < 0.05). After ending omeprazole, there was no significant change in any of the motor abnormalities of the esophagus and in gastric emptying time despite a marked improvement of symptoms and esophagitis in all patients. Sixteen patients were symptomatic when reevaluated on a clinical basis two months after ending therapy. We conclude that in children with severe GER disease, an abnormally high rate of both transient LES relaxation and LES pressure drift and slow gastric emptying are not affected by omperazole treatment, even though esophageal mucosal damage is markedly improved or cured. These abnormalities represent a primary motor disorder and can be implicated in the refractoriness of reflux disease. SN - 0163-2116 UR - https://www.unboundmedicine.com/medline/citation/9052509/Effects_of_omeprazole_on_mechanisms_of_gastroesophageal_reflux_in_childhood_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=9052509.ui DB - PRIME DP - Unbound Medicine ER -