Effect of azithromycin on acid reflux, hiatus hernia and proximal acid pocket in the postprandial period

Rohof, Wout O.; Bennink, Roel J.; Ruigh, Annemijn A. de; Hirsch, David P.; Zwinderman, Aeilko H.; Boeckxstaens, Guy E.

doi:10.1136/gutjnl-2011-300926

Cited by 74 publications

(42 citation statements)

References 40 publications

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“…In patients with a small hiatus hernia, azithromycin reduced hernia size and increased the amount of time it was in the reduced state. Acid refl ux was also reduced in these patients (38 % to 17 % ) while the total number of refl ux events was unchanged; no eff ects were observed in patients with large hiatus hernia ( 47 ). Th e gammaaminobutyric acid agonist, baclofen, has also been shown to significantly reduce the extent of the acid pocket in healthy volunteers.…”

Section: Therapeutic Agents and The Acid Pocketmentioning

confidence: 82%

“…Boecxstaens et al ( 32 ) demonstrated that the administration of the promotility drug erythromycin suppressed the acid pocket, while sumatriptan (a gastric relaxant) had an opposite eff ect. Similarly, Rohof et al ( 47 ) have shown that the prokinetic agent azithromycin can displace the acid pocket to a more distal location ( Figure 4 ). In patients with a small hiatus hernia, azithromycin reduced hernia size and increased the amount of time it was in the reduced state.…”

Section: Therapeutic Agents and The Acid Pocketmentioning

confidence: 99%

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The Acid Pocket: A Target for Treatment in Reflux Disease?

Kahrilas

McColl

Fox³

et al. 2013

American Journal of Gastroenterology

133

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The nadir esophageal pH of refl ux observed during pH monitoring in the postprandial period is often more acidic than the concomitant intragastric pH. This paradox prompted the discovery of the " acid pocket " , an area of unbuffered gastric acid that accumulates in the proximal stomach after meals and serves as the reservoir for acid refl ux in healthy individuals and gastroesophageal refl ux disease (GERD) patients. However, there are differentiating features between these populations in the size and position of the acid pocket, with GERD patients predisposed to upward migration of the proximal margin onto the esophageal mucosa, particularly when supine. This upward migration of acid, sometimes referred to as an " acid fi lm " , likely contributes to mucosal pathology in the region of the squamocolumnar junction. Furthermore, movement of the acid pocket itself to a supradiaphragmatic location with hiatus hernia increases the propensity for acid refl ux by all conventional mechanisms. Consequently, the acid pocket is an attractive target for GERD therapy. It may be targeted in a global way with proton pump inhibitors that attenuate acid pocket development, or with alginate / antacid combinations that colocalize with the acid pocket and displace it distally, thereby demonstrating the potential for selective targeting of the acid pocket in GERD.

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Section: Therapeutic Agents and The Acid Pocketmentioning

confidence: 82%

Section: Therapeutic Agents and The Acid Pocketmentioning

confidence: 99%

The Acid Pocket: A Target for Treatment in Reflux Disease?

Kahrilas

McColl

Fox³

et al. 2013

American Journal of Gastroenterology

133

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“…Vocal training involves changing from thoracic to abdominal breathing and would not strengthen the CD. The acid pocket position is important in the pathogenesis of GERD and can be changed pharmacologically (24). Would vocal training displace the acid pocket distally?…”

Section: Discussionmentioning

confidence: 99%

Inspiratory muscle training improves antireflux barrier in GERD patients

Souza

Lima

Martins

et al. 2013

American Journal of Physiology-Gastrointestinal and Liver Physi

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Nobre e Souza MÂ, Lima MJ, Martins GB, Nobre RA, Souza MH, de Oliveira RB, dos Santos AA. Inspiratory muscle training improves antireflux barrier in GERD patients. Am J Physiol Gastrointest Liver Physiol 305: G862-G867, 2013. First published October 10, 2013 doi:10.1152/ajpgi.00054.2013.-The crural diaphragm (CD) is an essential component of the esophagogastric junction (EGJ), and inspiratory exercises may modify its function. This study's goal is to verify if inspiratory muscle training (IMT) improves EGJ motility and gastroesophageal reflux (GER). Twelve GER disease [GERD; 7 males, 20 -47 yr, 9 esophagitis, and 3 nonerosive reflex disease (NERD)] and 7 healthy volunteers (3 males, 20 -41 yr) performed esophageal pH monitoring, manometry, and heart rate variability (HRV) studies. A 6-cm sleeve catheter measured average EGJ pressure during resting, peak inspiratory EGJ pressures during sinus arrhythmia maneuver (SAM) and inhalations under 17-, 35-, and 70-cmH2O loads (TH maneuvers), and along 1 h after a meal. GERD patients entered a 5-days-a-week IMT program. One author scored heartburn and regurgitation before and after IMT. IMT increased average EGJ pressure (19.7 Ϯ 2.4 vs. 29.5 Ϯ 2.1 mmHg; P Ͻ 0.001) and inspiratory EGJ pressure during SAM (89.6 Ϯ 7.6 vs. 125.6 Ϯ 13.3 mmHg; P ϭ 0.001) and during TH maneuvers. The EGJ-pressure gain across 35-and 70-cmH2O loads was lower for GERD volunteers. The number and cumulative duration of the transient lower esophageal sphincter relaxations decreased after IMT. Proximal progression of GER decreased after IMT but not the distal acid exposure. Low-frequency power increased after IMT and the higher its increment the lower the increment of supine acid exposure. IMT decreased heartburn and regurgitation scores. In conclusion, IMT improved EGJ pressure, reduced GER proximal progression, and reduced GERD symptoms. Some GERD patients have a CD failure, and IMT may prove beneficial as a GERD add-on treatment. crural diaphragm; GERD; lower esophageal sphincter; muscle training

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“…22 Macrolides improve gastric emptying and reduce gastroesophageal reflux, 23,24 and it is tempting to speculate that these effects contribute to a reduction in COPD exacerbations.…”

mentioning

confidence: 99%