Esophageal Acidification During Nocturnal Acid-breakthrough with Ilaprazole Versus Omeprazole in Gastroesophageal Reflux Disease

Karyampudi, Arun; Ghoshal, Uday C; Singh, Rajan; Verma, Amrisha; Misra, Asha; Saraswat, Vivek A.

doi:10.5056/jnm16087

Cited by 12 publications

(8 citation statements)

References 43 publications

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“…Hence, there may be some overlap between PI-IBS and PI-MAS in the Indian sub-continent[ 83 , 86 , 96 ] and some cases of PI-MAS may be erroneously diagnosed as cases of PI-IBS. In a recent study from Dhaka, Bangladesh, 10% of 23 patients with acute gastroenteritis fulfilling Rome III criteria for IBS in the absence of previous IBS were found to have PI-MAS on investigation[ 98 ].…”

Section: Pathophysiological Insightsmentioning

confidence: 99%

Epidemiological and clinical perspectives on irritable bowel syndrome in India, Bangladesh and Malaysia: A review

Rahman

Mahadeva

Ghoshal

2017

WJG

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Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder, common in clinic and in the community. It has a significant impact on both society and patients’ quality of life. The epidemiology, clinical presentation, and management of IBS may vary in different geographical regions due to differences in diet, gastrointestinal infection, socio-cultural and psycho-social factors, religious and illness beliefs, symptom perception and reporting. Although previous reviews and consensus reports on IBS in Asia have been published, Asia is quite diverse socio-demographically. In this context, India, Bangladesh and Malaysia share some similarities, including: (1) large proportion of the population living in rural areas; (2) rapid development and associated lifestyle changes in urban areas; and (3) dietary, cultural and religious practices. The present review explores the clinical and epidemiological data on IBS from these three major nations in South and South-East Asia. In-depth review of the literature revealed important differences between IBS in the East, as revealed by studies from these three countries, and the West; these include a predominantly rural profile, differences in bowel habit and symptom profile, raising concern with regards to diagnostic criteria and subtyping of IBS, higher dietary fiber consumption, frequent lactose malabsorption, parasitosis, and possible overlap between post-infectious IBS and tropical sprue. Moreover, the current perception on difference in prevalence of the disorder in these countries, as compared to the West, might be related to variation in survey methods.

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Section: Pathophysiological Insightsmentioning

confidence: 99%

Epidemiological and clinical perspectives on irritable bowel syndrome in India, Bangladesh and Malaysia: A review

Rahman

Mahadeva

Ghoshal

2017

WJG

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“…In patients with GERD, maintaining a pH >4 is one of the best measures for alleviating gastroesophageal injury 19,29 . Despite using various approaches, including increasing the frequency of medication, PPIs with longer t 1/2 such as ilaprazole, and the additional bedtime dosing of H2RAs, NAB has always been regarded as an unmet need of partial ASDs such as PPIs and H2RAs 20,30–33 . Treatment failures, especially reflux episodes at night, may be caused by PPIs irreversible binding to H + /K + ‐ATPase and gastric acid secretion (a circadian profile between 10 p.m. and 2 a.m.) 20,32 .…”

Section: Discussionmentioning

confidence: 99%

“…tion, PPIs with longer t 1/2 such as ilaprazole, and the additional bedtime dosing of H2RAs, NAB has always been regarded as an unmet need of partial ASDs such as PPIs and H2RAs 20,[30][31][32][33]. TreatmentF I G U R E 5 The cumulative rank probability plot of night-time acid suppression effect under different treatment regimens.…”

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confidence: 99%

Acid‐suppressive drugs: A systematic review and network meta‐analysis of their nocturnal acid‐inhibitory effect

Zou,

Ouyang,

Cheng

et al. 2023

Pharmacotherapy

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Background and AimsAcid‐suppressive drugs (ASDs) are widely used in many gastric acid‐associated diseases. Nocturnal acid breakthrough has been a common problem of many ASDs, such as proton‐pump inhibitors (PPIs) and H2‐receptor antagonists (H2RAs). Potassium‐competitive acid blockers (P‐CABs) are expected to solve this continuing conundrum. This article examined major ASDs and compared them with placebo in terms of nocturnal acid‐inhibitory effects, using a network meta‐analysis of randomized controlled trials (RCTs).MethodsTo compare the effectiveness of major ASDs, a Bayesian network meta‐analysis (NMA) was applied to process data extracted from RCTs. The plausible ranking for each regimen and some subgroups were assessed by surface under the cumulative ranking curves (SUCRA).ResultsFifty‐five RCTs were conducted with 2015 participants. In terms of nocturnal acid‐inhibitory effects, the overall results showed that tegoprazan (SUCRA 91.8%) and vonoprazan (SUCRA 91.0%) had the best performance, followed by new PPIs (including tenatoprazole and ilaprazole) (SUCRA 76.6%), additional H2RAs once at bedtime (AHB) (SUCRA 61.3%), isomer PPIs (including esomeprazole and dexlansoprazole) (SUCRA 38.6%), revaprazan (SUCRA 34.7%), traditional PPIs (including omeprazole, rabeprazole, pantoprazole, lansoprazole) (SUCRA 32.6%), H2RAs (SUCRA 23.1%), and placebo (SUCRA 0.3%). In some subgroups, the nocturnal acid‐inhibitory effect of vonoprazan or tegoprazan was better than most of the other regimens, even new PPIs and AHB.ConclusionsThis is the first study to compare the effect of ASDs on inhibiting nocturnal acid breakthrough. Overall, in terms of nocturnal acid‐inhibitory effect, vonoprazan and tegoprazan had an advantage against other regimens including H2RAs, isomer PPIs, traditional PPIs, AHB, and new PPIs. Even in some subgroups, such as language classification (English), types of study design (crossover‐RCT), age (≤40 years), BMI (18.5–24.9 kg/m2), continent (Asia and North America), disease status (health), the duration of therapy (2 weeks), and time of administration (at daytime or at night‐time), the nocturnal acid‐inhibitory effect of vonoprazan or tegoprazan were better than most regimens, even AHB and new PPIs.

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“…2,[4][5][6][7][8][9][10][11][12] What is the treatment effect of PPIs, which are known to have a longer plasma half-life on NAB? In this issue of the Journal of Neurogastroenterology and Motility, Karyampudi et al 13 evaluated esophageal acidification during NAB with ilaprazole, versus omeprazole in patients with uncomplicated GERD, in a prospective manner. A total of 58 patients with GERD prescribed 10 mg of ilaprazole or 20 mg of omeprazole once daily for more than 1 month were enrolled in this study, and underwent 24-hour impedancepH monitoring.…”

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confidence: 99%

“…14 In another study, 10 mg or higher of ilaprazole may provide better control of NAB, nocturnal esophageal acidification, and nocturnal symptoms. 13 Another important thing in this study was that the authors evaluated the clinical significance of NAB. The frequency and duration of nocturnal esophageal acidification and nocturnal symptoms were comparable with or without NAB.…”

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Can Nocturnal Acid-breakthrough Be Reduced by Long-acting Proton Pump Inhibitors?

Jeon

Kim

2017

J Neurogastroenterol Motil

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Gastroesophageal reflux disease (GERD) is a condition characterized by reflux of the gastric contents causing troublesome symptoms and complications.1 Proton pump inhibitors (PPIs) are the mainstay of treatment for GERD and significantly decrease gastric acid secretion. In spite of their potent acid suppression, PPIs cannot eliminate intragastric acidity, particularly during the night. PPIs have a relatively short plasma half-life and all proton pumps are not active at the same time. Therefore, during the night, the morning dosed PPIs are no longer effective on acid suppression of newly activated proton pumps. During the night, there is no gravity-mediated drainage and significant reduction in swallows; thus, reflux episodes are of longer duration. 2 Based on these circumstances, nocturnal acid-breakthrough (NAB) has been the subject of attention to describe refractory GERD. NAB was first described as a decrease in gastric pH less than 4 for at least 60 consecutive minutes in the overnight period in patients on twice-daily PPIs treatment. Originally, the rationale behind measuring intragastric pH and presence of NAB was that the stomach is the source of acid in the refluxate; suppression of gastric acid may reduce the injurious effect of the refluxate in GERD. To overcome short plasma half-life of PPIs, several pharmacological attempts have been made to control NAB with different regimens and doses of PPIs. In addition, investigators have also attempted to eliminate NAB by targeting the night time histamine surge, with administration of histamine H2 receptor antagonists (H2RA) ( Table). 2,[4][5][6][7][8][9][10][11][12] What is the treatment effect of PPIs, which are known to have a longer plasma half-life on NAB? In this issue of the Journal of Neurogastroenterology and Motility, Karyampudi et al 13 evaluated esophageal acidification during NAB with ilaprazole, versus omeprazole in patients with uncomplicated GERD, in a prospective manner. A total of 58 patients with GERD prescribed 10 mg of ilaprazole or 20 mg of omeprazole once daily for more than 1 month were enrolled in this study, and underwent 24-hour impedancepH monitoring. A total of 72.4% of patients had NAB. Despite the long-action of ilaprazole, its frequency, duration, and mean intra-gastric pH during NAB, as well as nocturnal esophageal acidification and nocturnal symptoms were comparable between the

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Esophageal Acidification During Nocturnal Acid-breakthrough with Ilaprazole Versus Omeprazole in Gastroesophageal Reflux Disease

Cited by 12 publications

References 43 publications

Epidemiological and clinical perspectives on irritable bowel syndrome in India, Bangladesh and Malaysia: A review

Epidemiological and clinical perspectives on irritable bowel syndrome in India, Bangladesh and Malaysia: A review

Acid‐suppressive drugs: A systematic review and network meta‐analysis of their nocturnal acid‐inhibitory effect

Can Nocturnal Acid-breakthrough Be Reduced by Long-acting Proton Pump Inhibitors?

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