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An evaluation of the clinical implications of acid breakthrough in patients on proton pump inhibitor therapy
Author(s) -
Nzeako U. C.,
Murray J. A.
Publication year - 2002
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.2002.t01-1-01281.x
Subject(s) - medicine , reflux , proton pump inhibitor , nocturnal , refractory (planetary science) , gastro , gastric acid , gastroenterology , disease , gerd , omeprazole , stomach , physics , astrobiology
Summary Background : Some patients with gastro‐oesophageal reflux disease continue to experience symptoms despite therapy with proton pump inhibitors. One recently proposed cause is the occurrence of nocturnal acid breakthrough. Aim : To investigate the relationship between acid breakthrough occurrence (nocturnal and daytime) and refractory symptoms among patients with gastro‐oesophageal reflux disease on proton pump inhibitors. Methods : Fifty‐two consecutive patients with persistent symptoms of gastro‐oesophageal reflux disease despite proton pump inhibitor therapy underwent 24‐h pH study at the Mayo Clinic between January 1 and November 10, 1999. Relevant data were extracted and analysed. Results : Fifty‐two patients, 18 males and 34 females, were eligible for the study. The mean age was 53 ± 2.2 years. Thirty‐seven patients (71%) had nocturnal acid breakthrough, and 36 (69%) had daytime acid breakthrough. Sixty per cent of patients experienced both nocturnal and daytime acid breakthrough, whereas 19% had neither. Among those with nocturnal and daytime acid breakthrough, only 36% and 33% of symptoms, respectively, were associated with gastro‐oesophageal reflux episodes. The proportion of patients with symptoms and the mean symptom scores were not significantly different between those with and without acid breakthrough. Conclusions : Gastric acid breakthrough occurs nocturnally and during the daytime in patients on proton pump inhibitor therapy. With less than 36% of refractory symptoms associated with gastro‐oesophageal reflux, gastric acid breakthrough cannot explain symptom refractoriness to proton pump inhibitor therapy in a significant majority of patients evaluated by 24‐h pH study.