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The basis for the decreased response to proton pump inhibitors in gastro‐oesophageal reflux disease patients without erosive oesophagitis
Author(s) -
Gardner J. D.,
GalloTorres H.,
Sloan S.,
Robinson M.,
Miner P. B.
Publication year - 2003
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.1365-2036.2003.01777.x
Subject(s) - heartburn , gastroenterology , medicine , omeprazole , rabeprazole , proton pump inhibitor , reflux , gastro , esophagitis , esophageal disease , gerd , refractory (planetary science) , disease , esophagus , physics , astrobiology
Summary Background : The reason why heartburn in gastro‐oesophageal reflux disease subjects without oesophagitis is less responsive to proton pump inhibitors than heartburn in those with erosive oesophagitis is not known. Methods : Gastric and oesophageal pH were determined in 26 subjects with gastro‐oesophageal reflux disease at baseline and on days 1, 2 and 8 of treatment with 20 mg omeprazole or 20 mg rabeprazole in a randomized, two‐way cross‐over fashion. The presence or absence of erosive oesophagitis at baseline was documented by upper gastrointestinal endoscopy. Results : At a given value of the integrated gastric acidity during treatment with a proton pump inhibitor, the probability of pathological oesophageal reflux was significantly higher in subjects with no oesophagitis than in those with erosive oesophagitis. This occurred because the post‐prandial gastric acidity in subjects with no oesophagitis showed a decreased response to the antisecretory agent. Conclusions : Compared with gastro‐oesophageal reflux disease subjects with erosive oesophagitis, those with no oesophagitis are relatively refractory to the pharmacodynamic effects of proton pump inhibitors on the post‐prandial integrated gastric acidity.