Shuwen Xue

Bedtime H2 blockers improve nocturnal gastric acid control in GERD patients on proton pump inhibitors.

Proton pump inhibitors taken twice daily before meals (proton pump inhibitor b.d. AC) effectively controls daytime gastric pH; however, nocturnal gastric acid breakthrough (NAB) occurs in more than 75% of patients. Adding an H2‐blocker at bedtime decreases NAB in normal subjects. The efficacy of this regimen has not been evaluated in GERD patients. The aim of this study was to assess the effects of proton pump inhibitor b.d., both with and without bedtime H2‐blocker on intragastric pH and the occurrence of NAB in GERD patients.

Postprandial stomach contents have multiple acid layers.

Goals The purpose of this study was to evaluate patterns in gastric pH both fasting and postprandially in different body positions. Study Ten healthy volunteers were studied. A pH probe was positioned with an electrode 15 cm below the lower esophageal sphincter proximal border then withdrawn 1 cm every 30 seconds to 5 cm above the lower esophageal sphincter. Volunteers were tested on 2 occasions. Initially, they were studied in a semirecumbent position (45 degrees), with the first pull-through after 6 hour fasting. After a meal, a pull-through was repeated 4 consecutive times (approximately 15, 30, 45, and 60 min). On a subsequent day, the positions were changed with each pull-through: upright, supine, right decubitus, and left decubitus. The order of these positions was randomly selected. Results The pH step-up is defined as a change in pH from a gastric to an esophageal pH (<4→>4). No significant difference was found between location of the pH step-up in the fasting and postprandial pull-throughs. An area of lower pH was consistently found within 2 cm distal to the step-up area. Distal to the area of higher gastric pH (median pH at 5), a second acid layer was found. This pattern persisted through the 4 postprandial pull-throughs, irrespective of body position. Conclusions The pH step-up was persistent in the fasting period and for 1 hour postprandially, but did not migrate proximally. Gastric buffering from a meal creates a nonuniform environment with at least 2 acid layers. This pattern is present irrespective of body position. The lack of homogeneity of stomach content postprandially helps to explain the observation of occasional persistent acid gastroesophageal reflux after a meal.

Control of intragastric pH with omeprazole 20 mg, omeprazole 40 mg and lansoprazole 30 mg.

Single daily doses of proton pump inhibitors, omeprazole and lansoprazole provide effective acid suppression and equal healing and symptom relief in patients with GERD. Despite this, controversy exists as to the efficacy of available proton pump inhibitors in the control of gastric acidity.

The acidity index: a simple approach to the measurement of gastric acidity.

Background : The percentage of time intragastric pH < 4 is a major parameter in evaluating the efficiency of acid‐suppressive therapies. This parameter is easy to calculate, but does not identify the actual pH level. Recent studies have recommended the use of the integrated intragastric acidity as a more refined method of assessing intragastric acid control.

Addition of bedtime H2 blocker to PPI bid decreases nocturnal gastric acid burden in GERD patients

Addition of bedtime H 2 blocker to PPI bid decreases nocturnal gastric acid burden in GERD patients