Gastro‐oesophageal reflux associated with nocturnal gastric acid breakthrough on proton pump inhibitors

Katz,; Anderson, Laura N.; Khoury,; Castell,

doi:10.1046/j.1365-2036.1998.00419.x

Cited by 170 publications

(146 citation statements)

References 10 publications

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“…The initial salivary pH is correlated with pH in the lower esophagus and is higher in GER subjects than in control subjects (8). In addition, Katz et al (9) ORIGINAL A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma Naoto Burioka 1 , and Eiji Shimizu detected nocturnal gastric acid breakthrough (NAB), defined as nighttime periods exceeding 1 h with a gastric pH below 4.0, in 67% of normal subjects ; and it was previously reported that there is a nocturnal decline of salivary pH in healthy subjects (10). Saliva is an important determinant of esophageal acid neutralization in patients with NAB as well as in GER patients (8).…”

Section: Introductionmentioning

confidence: 99%

A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma

et al. 2010

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: Salivary pH is associated with esophageal acid reflux and neutralization of esophageal acid. In this study, we assessed the association between nocturnal decline of salivary pH and airway hyperresponsiveness. Salivary pH was serially assessed in 9 patients with mild asthma (7 men and 2 women ; mean age 33.3 years ; mean % %predicted FEV1.0 89.4% %) and 10 healthy volunteers (6 men and 4 women ; mean age 31.2 years) using a pH indicator tape. The buffering capacity of saliva was defined as the median effective dose (ED50) for acidification of saliva with 0.01 N HCl, and airway responsiveness was defined as the dose of methacholine producing a 35% % fall in Grs (PD35-Grs). There was a significant correlation between the values obtained from the pH indicator tape and those obtained from the electrometric pH meter. Using the indicator tape for sequential monitoring, we observed a nocturnal fall (!pH) in salivary pH in all subjects. A significant correlation was found between airway hyperresponsiveness (PD35-Grs) and either !pH or ED50 in mildly asthmatic patients. Vagal reflux dysfunction might contribute to nocturnal salivary pH as well as to airway hyperresponsiveness in mild asthmatics. J. Med. Invest.

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Section: Introductionmentioning

confidence: 99%

A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma

et al. 2010

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“…17 NAB was as high as 90% in patients taking once daily omeprazole in one study. 4 Katz et al 5 showed that NAB occurred in 70% of patients with GERD while taking twice daily omeprazole. 5 Similar results were shown by other studies as well using twice daily omeprazole.…”

Section: Discussionmentioning

confidence: 99%

“…4 Katz et al 5 showed that NAB occurred in 70% of patients with GERD while taking twice daily omeprazole. 5 Similar results were shown by other studies as well using twice daily omeprazole. [18][19][20]21 On the contrary, one of our previous studies showed lower frequency of NAB among patients taking once daily omeprazole, though the number of patients studied was less than that in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Nocturnal acid-breakthrough (NAB), defined as persistent reduction of intragastric pH below 4 for more than 60 minutes during the night, occurs in 40% to 70% of patients with GERD while on proton pump inhibitors (PPIs). [4][5][6] Though an additional night time dose of PPI and/or histamine H2 receptor antagonist has been suggested to treat NAB, 7 the evidence suggesting the need for such treatment is scanty since only a few small studies suggested that NAB is merely a laboratory phenomenon, as esophageal acidification and symptoms are uncommon during NAB. 6,8 Dual channel 24-hour pH-metry, a technique used to study esophageal acid exposure and intra-gastric pH over a 24-hour period, has been used to study NAB while on treatment with PPIs.…”

Section: Introductionmentioning

confidence: 99%

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

Karyampudi

Ghoshal

Singh

et al. 2017

J Neurogastroenterol Motil

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Background/AimsThough nocturnal acid-breakthrough (NAB) is common in gastroesophageal reflux disease (GERD) patients, its clinical importance results from esophageal acidification, which has been shown to be uncommon. Ilaprazole, a long-acting proton pump inhibitor, may cause NAB infrequently. Accordingly, we studied prospectively, (1) frequency and degree of esophageal acidification during NAB, and (2) frequency and severity of NAB while on ilaprazole versus omeprazole. MethodsFifty-eight consecutive patients with GERD on once daily ilaprazole, 10 mg (n = 28) or omeprazole, 20 mg (n = 30) for > one month underwent 24-hour impedance-pH monitoring prospectively. NAB was defined as intra-gastric pH < 4 for > one hour during night, and esophageal acidification as pH < 4 for any duration. Nocturnal symptoms (heartburn, regurgitation, and chest pain) were also recorded. Results Of ConclusionsThough NAB was common while patients were on a proton pump inhibitor, esophageal acidification was uncommon. Frequency and severity of NAB were comparable among patients on ilaprazole and omeprazole, except for the lesser number of NABs with ilaprazole.

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“…Nocturnal acid breakthrough does occur in a subset of patients, but will usually be controlled by an evening dose of proton pump inhibitor. 15 Unfortunately, H 2 RAs, whilst initially effective in reducing nocturnal acid, typically are subject to the development of tolerance. An alternative approach is to prescribe an H 2 RA on an as-needed basis before bedtime, to assist with night-time symptomatology.…”

Section: What To Do If Long-term Management Failsmentioning

confidence: 99%

Overview: initial and long‐term management of gastro‐oesophageal reflux disease

Talley

2003

Aliment Pharmacol Ther

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Summary Initial management of gastro‐oesophageal reflux disease aims to confirm a symptom‐based diagnosis, to relieve symptoms, to reassure the patient as to the treatable nature of reflux disease, and to initiate risk management and healing of oesophagitis. The aims of long‐term management include adequate control of symptoms, prevention of complications, and improvement of quality of life. Management options in terms of use of proton pump inhibitors are either daily therapy (maintenance), intermittent courses of therapy (for example, 4 weeks, then cease and observe), or on‐demand therapy. This overview discusses the advantages and disadvantages of these different strategies for the management of reflux disease.

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Gastro‐oesophageal reflux associated with nocturnal gastric acid breakthrough on proton pump inhibitors

Abstract: Nocturnal acid breakthrough is frequently seen on proton pump inhibitors twice daily and is often accompanied by oesophageal reflux. This has important implications for medical therapy in patients with severe gastro-oesophageal reflux and Barrett's oesophagus.

Cited by 170 publications

References 10 publications

A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma

A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma

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

Overview: initial and long‐term management of gastro‐oesophageal reflux disease

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